Redo Operations for Recurrent Dissection After Operation for Type A Aortic Dissection / 대한흉부외과학회지

BACKGROUND: Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 2000, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. MATERIAL AND METHOD: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. RESULT: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperation cases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years. All patients who underwent reoperation survived. Postoperative complications were bleeding and tracheostomy in 1, mediastinitis in 1 and transient delirium in 1 case. Postoperatively, all the patients were followed-up in regular interval. Five patients were evaluated with computerized tomography, 1- 79months(mean: 31.5months) after the reoperation. The false lumen had regressed in 1 cases, persisted without progression in 4 cases. CONCLUSION: The clinical results of reoperation after type A aortic dissection operation were satisfactory. In younger patients with Marfan syndrome, the risk of reoperation was high. Careful and regular follow-up for the persistent false lumen is necessary.

Arterry Bypas Graft with the Right Gastroepiploic Artery: Clinical and Angiographic Short-Term Results / 대한흉부외과학회지

BACKGROUND: The right gastroepiploic artery(RGEA) has been use in coronary artery bypass grafting from 1987. The RGEA is the most useful arterial conduit in coronary artery bypass grafting(CABG) followed by the internal mammary artery, MATERIALS AND METHOD: From Septermber 1998 to February 1999 the RGEA was used for coronary artery bypass grafting in 11 patients 10 males and 1 female. Postoperative angiography was performed in all of the patients before discharge RESULT: Early patent rate of the RGEA was 100%. The flow competition of the REGA graft was seen in 4 patients(36.4%) The flow pattern war RGEA dependent type in the inner diameter of the recipient coronary artery 1.5 mm the inner diameter of the RGEA 2.5 mm and the rtio of inner diameter of the RGEA and the recipient coronary artery 1(p<0.05) CONCLUSION: Early results of CABG with RGEA was satisfactory. However the RGEA graft has a tendency of flow competition in relation to the inner diameter of graft. Preoperative angiographic evaluation for RGEA and meticulous operative technique are required for a good surgical results.