• Journal of Chest Surgery
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• 제27권1호
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• pp.31-35
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• 1994

Dissecting aortic aneurysm is a life threatening condition which necessitates prompt diagnosis and management. Between January 1987 and September 1993,58 patients was admitted to our department. Mean age at admission was 53 years.[range 25-82]. Clinical findings included chest pain in 48 cases[83%],renal failure in 12[20%],aortic insufficiency in 11[19%] and stroke in 9[15%]. Predisposing factors were hypertension in 50 cases[86%],Marfan`s syndrome in 6[10%] and diabetes melitus in 1 [2%]. 23 patients[ type A 13,type B 10 ] underwent surgical treatment. Surgical technique for type A included graft replacement of ascending aorta in 7 cases,graft replacement and aortic valve resuspension in 3,and Bentall`s operation in 3 cases. Type B patients were operated when specific indications applied. There were three [Two in type A and 1 in type B] deaths in the operation group and nine [ 5 in type A and 4 in type B] deaths in the medical group. These results support our current policy in the treatment of dissecting aortic aneurysm.

• Journal of Chest Surgery
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• 제30권3호
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• pp.300-307
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• 1997

인제대학교 부속 부산백병 원 흉부외과학교실에서는 지난 87년 10월부터 96년 1월까지 총25례의 흉부 및 복부 대동맥류를 수술로 치험하였다. 환자의 연령은 최소 26세에서 최고 73세(평균연령 52. 5세)였으며 남자가 13명 여자가 12명이였다. 발생 부위에 따라흉부 대동맥류가 18례 복부 대동맥류가7례였다. 원인에 따른 분류에서 16례가 박리성이 였으며 9례가 비박리성 대동맥류였다. 동맥류의 위험 인자로는 고혈압이 가장 많았으며 기타 고지질증, Marfan증후군등이였다. 흉부 대동맥류는 침범 부위에 따라 동맥류 절제술과 인조혈관 대치술 및 관상동맥 이식술등을 증례에 따라적절히 시행하였다. 복부 대동맥류는 동맥류 절제후 침범 부위에 따라 일자 또는 역Y형 인조혈관 을 대 치시켰다. 총 5례의 술후 사망이 있어서 수술 사망률은 20%였으며 생존 환자는 특별한 합병증 없이 퇴원하였다.

• Journal of Chest Surgery
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• 제21권1호
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• pp.184-190
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• 1988

The treatment of aortic aneurysm of ascending aorta has been fraught with difficult surgical problems. For the most part, these were resolved in 1968 with the introduction of a technique of total replacement of ascending aorta and reimplantation of the coronary arteries by Bentall and De Bono. This technique however, with all of its advantages, caries a certain problems. In chronic dissecting aneurysms, there is frequently a marked disparity in circumference between the true and false lumen distally. Distal perfusion is directed into both the true and false lumens by removing segment of the septum between the two lumens and constructing the distal graft anastomosis is to the outer layer of aortic adventitia. The distal false lumen, aortic branches and fenestrations have matured and healed in most cases. And importantly, major aortic tributaries may be solely dependent on the false lumen for perfusion. We are presenting two cases of chronic dissecting aneurysm of ascending aorta with aortic regurgitation, who have good result by surgical correction of so-called Bentall procedure with maintenance of blood flow directed into both true and false lumen.

• Journal of Chest Surgery
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• 제18권2호
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• pp.305-313
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• 1985

Surgical therapy for dissection of the aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. Recently, a new method of treatment with an intraluminal graft that requires no end-to-end anastomosis has been developed. Of the four patients with dissecting aneurysm of the aorta treated by inserting sutureless ringed intraluminal graft at the Department of Thoracic and Cardiovascular Surgery, S.N.U.H., three were DeBakey type I [one with associated aortic insufficiency] and the other was DeBakey type III. Suspected etiology of the dissection was Marfan`s syndrome in one and hypertension in the others. Total cardiopulmonary bypass was utilized in repairing dissecting aneurysms of the ascending aorta [type A] and simple aortic crossclamping was used for the patient with dissecting aneurysm of the descending aorta. The basic technique consists of inserting the whole ringed graft into the true lumen of the dissected aorta and circumferentially ligating the aorta against the groove in the rings. The proximal ring of the graft effectively stabilized the flail aortic valve in patient with aortic insufficiency associated with dissection of the ascending aorta. There were no hospital deaths and one patient with type III dissecting aneurysm developed postoperative paraparesis and renal insufficiency which was resolved. Follow-up has been from 1 month to 16 months with no evidence of prosthetic problems, such as erosion, migration, or thrombosis.

• Journal of Chest Surgery
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• 제20권2호
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• pp.367-373
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• 1987

Dissecting aneurysm has long been recognized as an ominous and highly lethal form of aortic disease. Aortic dissection are characterized by longitudinal separation of aortic media and extension proximally, distally or both from the site of intimal tear. DeBakey and associates defined three types based on where the process originates and how far extends. In type I, intimal tear is located in the ascending aorta and extend beyond the descending aorta. We experienced a case of dissecting aneurysm, Type I of DeBakey`s classification which dissection extend to the left iliac artery. The patient was 61 years old woman and suffered from excruciating pain on admission. Excision of aneurysm and ascending aorta reconstruction using to Dacron Vascular Prosthesis were performed under extracorporeal circulation. The post-operative course was uneventful and follow up is continued.

• Journal of Chest Surgery
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• 제14권3호
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• pp.291-296
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• 1981

Dissecting aortic aneurysm is a disease which is characterized by hemorrhagic intramural seperation of aortic wall and extension for varlng distances proximally, distally, or both from the site of the intimal tear. Most aortas show some type of medial degeneration most commonly described as cystic medial necrosis. DeBackey classified this disease according to involved aorta and site of intimal tear to 3 basic types, such as type I, II and III. Type III is defined that dissecting process arrises in the descending thoracic aorta just distal to origin of the left subclavian artery and extends distally for a varing distance. We expirienced a case of dissecting aneurysm, type III of DeBackey's classification which dissecting process is limited to the descending thoracic aorta in the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital. This patient was 40 year old woman and she had suffered from intermittent sharp back pain for 3 years .before admission. Excision of the aneurysm and Dacron graft were placed successfully under the left atrio-femoral bypass with artificial pump. The hospital course was uneventful.

• Journal of Chest Surgery
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• 제35권8호
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• pp.599-604
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• 2002

급성 혹은 만성 대동맥 해리증은 파열을 일으킬 수 있는데 이는 사망의 주요 원인이 된다. 상행대동맥의 해리성 동맥류(Stanford A형 대동맥 해리증)는 극히 드물게 상대정맥으로 파열되어 대동백-상대정맥루를 형성할 수 있는데 대동백-하대정맥루는 복부 대동맥류 환자에서 이따금씩 보고되어 왔다. 최근 상대정맥증후군의 증상을 가진 67세 남자환자에서 CT, MR angiography, 동맥촬영 등 방사선학적 검사결과 Stanford A형 대동맥 해리증 및 대동맥-상대정맥루가 진단되었다. 해리된 동맥류는 절제 후 인조혈관으로 치환되었고 대동맥-상대정맥루는 초저온 순환정지 상태에서 교정되었다. 이에 대해 상세하게 기술하는 바이다.

• Journal of Chest Surgery
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• 제17권4호
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• pp.687-690
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• 1984

Aortic dissection, a condition characterized by hemorrhage into the media and variable extension along the length of the aorta, has long been recognized as a catastrophic Cardiovascular event. Recent developments in diagnostic and therapeutic skills have improved the prognosis considerably, but there is still controversy as to how cases should be managed. We experienced a case of dissecting aortic aneurysm [DeBakey Type III ], which were managed using intensive medical treatment. The period of follow up was about 11 years. At last, patient was died by progression of dissection into proximal aorta and resulted in aortic insufficiency and congestive heart failure.

• Journal of Chest Surgery
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• 제47권6호
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• pp.548-551
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• 2014

Type II chronic dissecting thoracoabdominal aortic aneurysms are a surgically challenging disease. The conventional thoracoabdominal aortic aneurysm repair technique using cardiopulmonary bypass is a high-risk procedure. However, a recently developed endovascular technique may be an alternative treatment for the disease, but faces the obstacle of lesional restriction. This new technique uses a hybrid strategy to overcome the limits of endovascular thoracoabdominal aortic aneurysm repair. Herein, we report on a successful outcome after performing the hybrid visceral debranching procedure.

• Journal of Yeungnam Medical Science
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• 제5권1호
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• pp.159-166
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• 1988

Dissecting aortic aneurysm is relatively rare in those under 40 years of age without high risk factors. After dessecting aortic aneurysm is occured, the coronary artery is rarely perfused by false lumen. We present a thirty two-year-old man who showed Debakey type 1 dissecting aortic aneurysm with right coronary artery perfused by false lumen of ascending aorta and with congestive heart failure due to aortic insufficiency without discernible risk factor. Medical and surgical treament(Modified Bentall's operation) were successfully performed. The pathologic report showed combined cystic medial necrosis. Now he is well tolerated and stable only with anticoagulation during follow up 18 months.