Clinical Results of Ascending Aorta and Aortic Arch Replacement under Moderate Hypothermia with Right Brachial and Femoral Artery Perfusion

BACKGROUND: Selective antegrade perfusion via axillary artery cannulation along with circulatory arrest under deep hypothermia has became a recent trend for performing surgery on the ascending aorta and aortic arch and when direct aortic cannulation is not feasible. The authors of this study tried using moderate hypothermia with right brachial and femoral artery perfusion to complement the pitfalls of single axillary artery cannulation and deep hypothermia. MATERIALS AND METHODS: A retrospective analysis was performed on 36 patients who received ascending aorta or aortic arch replacement between July 2005 and May 2010. The adverse outcomes included operative mortality, permanent neurologic dysfunction and temporary neurologic dysfunction. RESULTS: Of these 36 patients, 32 (88%) were treated as emergencies. The mean age of the patients was 61.9 years (ranging from 29 to 79 years) and there were 19 males and 17 females. The principal diagnoses for the operation were acute type A aortic dissection (31, 86%) and aneurysmal disease without aortic dissection (5, 14%). The performed operations were ascending aorta replacement (9, 25%), ascending aorta and hemiarch replacement (13, 36%), ascending aorta and total arch replacement (13, 36%) and total arch replacement only (1, 3%). The mean cardiopulmonary bypass time was 209.4+/-85.1 minutes, and the circulatory arrest with selective antegrade perfusion time was 36.1+/-24.2 minutes. The lowest core temperature was 24+/-2.1degrees C. There were five deaths within 30 post-op days (mortality: 13.8%). Two patients (5.5%) had minor neurologic dysfunction and six patients, including three patients who had preoperative cerebral infarction or unconsciousness, had major neurologic dysfunction (16.6%). CONCLUSION: When direct aortic cannulation is not feasible for ascending aorta and aortic arch replacement, the right brachial and femoral artery can be used as arterial perfusion routes with the patient under moderate hypothermia. This technique resulted in acceptable outcomes.

Relationship between the Occurrence of Thromboembolism and INR Measurement Interval in Low Intensity Anticoagulation after Aortic Mechanical Valve Replacement

BACKGROUND: We investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement. MATERIALS AND METHODS: Seventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)(R) dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively. RESULTS: The observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were 97.10+/-2.02% at 5 years, 84.30+/-5.22% at 10 years, and 67.44+/-12.14% at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, 1.86+/-0.14 vs. thromboembolic group, 1.50+/-0.28, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, 49.04+/-9.47 days vs. thromboembolic group, 65.89+/-44.88 days, p<0.01). CONCLUSION: To prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.

Right Atrium Rupture as a Result of Blunt Trauma from a Traffic Accident: One case report / 대한흉부외과학회지

Traumatic cardiac injury is an extremely serious medical condition. It is possible to overlook a cardiac injury where there is no chest wall trauma. We here report the 47-year-old woman who got a crach car accident and had a tear of the right atrium. The distortion force from a decelerating injury may cause cardiac rupture at a fixed point. The most common symptom that alerts the clinician to a potentially fatal cardiac injury is the change in vital signs. Therefore cardiac injury should be considered in any patient with unexplained hypotension who has experienced decelerating trauma, even without external injury to the chest wall.

Thoracic Surgeon's Role in Differential Diagnosis of the Interstitial Lung Disease / 대한흉부외과학회지

BACKGROUND: Pathologic confirmation is needed to diagnose various forms of interstitial lung diseases. We wanted to find out how much the thoracic surgical lung biopsies will be needed for definite diagnosis of interstitial lung diseases. MATERIAL AND METHOD: 17 patients underwent surgical lung biopsy in the department of thoracic and cardiovascular surgery, Gyeongsang National University Hospital from June 1995 to November 2002. Chart review and telephone questionnaire were done for retrospective study. RESULT: Mean age was 49+/-22 years. Age ranged from 1 to 70 years. Dyspnea was the most common complaint. They were referred for definite differClinical Evaluation of Instrumental ential diagnosis from pediatrics and internal medicine. Biopsy methods were thoracotomy in 11 cases, and thoracoscopy in 6 cases. Pathologic confirmation was possible in 11 cases (65%). According to the pathologic reports, treatment plans were changed in 13 cases (76%). CONCLUSION: Surgical lung biopsy was effective method in differentiating diagnosis of the interstitial lung disease. There was no mortality during operation. It is important that undiagnosed fibrous lung disease should be recommanded the lung biopsy for planning patient's treatment.

Cystic Lymphangioma in the Chest Wall of the Child: A case report / 대한흉부외과학회지

Lymphangioma is a developmental anomaly that is known to occur in the neck and axilla, and only rarely in the mediastinum, retroperitoneum, groin and pelvis. An isolated chest wall lymphangioma is a rare benign neoplasm. In case of large sized lymphangioma, surgical excision is preferably recommended as the treatment of choice. We operated on a three-year old female for excision of chest wall. In pathologic diagnosis, it diagnosed the mass as chest wall lymphangioma.

Cystic Lymphangioma in the Chest Wall of the Child: A case report / 대한흉부외과학회지

Lymphangioma is a developmental anomaly that is known to occur in the neck and axilla, and only rarely in the mediastinum, retroperitoneum, groin and pelvis. An isolated chest wall lymphangioma is a rare benign neoplasm. In case of large sized lymphangioma, surgical excision is preferably recommended as the treatment of choice. We operated on a three-year old female for excision of chest wall. In pathologic diagnosis, it diagnosed the mass as chest wall lymphangioma.

Significance of p53 as a Prognostic Factor in Non-Small Cell Lung Carcinoma / 대한흉부외과학회지

BACKGROUND: The treatment results of the advanced lung carcinoma is not satisfactory with the present therapeutic modalities: surgical resection, anti-cancer chemotherapy, and radiotherapy or combination therapy. To predict the prognosis of the non-small-cell lung carcinoma, TNM classification has been was as the basic categorization; however, it has been not satisfactory. It is necessary to consider the causes and the prognosis of the lung carcinoma from another points of view rather the conventional methods. We intended to find out the relationship between the major apoptotic factor, p53 gene and the prognosis of the patient with lung carcinoma. MATERIAL AND METHOD: Three hundreds and fifty-nine patients with lung carcinoma who underwent surgery were analysed. We observed p53 protein accumulated in the cellular nuclei. The p53 protein was detected by immuno-histo-chemical method. We collected information of the patient retrospectively. RESULT: p53 protein densities were observed in 40% in average as a whole. The protein density was 44 percent in man, 25 percent in woman, 49 percent in the squamous cell carcinoma, and 38 percent in the adenocarcinoma. There were significant correlations between the p53 protein density and the mortality in the squamous cell carcinoma (p=0.025), follow-up duration in TNM stage I group (p=0.010), and follow-up duration in the lobectomy patient group (p=0.043), and tumor cell differentiation (p=0.009). p53 protein densities were significantly different between the lobectomy and the pneumonectomy group (p=0.044). CONCLUSION: The authors found that p53 protein had some correlations with the prognosis of the lung cancer partially in some factors. We suggest the p53 protein density could be used as a marker of prognosis in the non-small-cell lung carcinoma.

Surgical Treatment for Multiple Primary Lung Cancer: Report of 2 cases / 대한흉부외과학회지

Multiple primary lung cancer is classified into a synchronous primary lung cancer or a metachronous primary lung cancer. Both are rarely encountered disease entities. We report our surgical experience of each one case of synchronous and metachronous primary lung cancer.

Treatment of Traumatic Vascular Injury / 대한흉부외과학회지

BACKGROUND: Vascular injury has been increased with popular outside activities. However there are only a few studies for vascular trauma. We intended to find out the relationships between the vascular trauma and its prognosis. MATERIAL AND METHOD: Forty-four patients were diagnosed and operated on for vascular injury in the Gyeongsang National University Hospital from 1992 to 1999. We reviewed their chart and analysed their data retrospectively. We studied te causes, treatments, and prognoses of traumatic vascular injury. RESULT: The transfer time between accident place and emergency department was mean 3.5 hour, and the operation preparing time was 8.8 hours. Five cases required amputation of extremity. All amputation cases were combined with communited bony fractures. Thirty-eight cases had combined other injuries, and almost combined injuries were muscular and neurological damages. CONCLUSION: The optimal treatment plan for vascular trauma was prompt diagnosis and quick management. It may decrease amputation rate and post-traumatic complications. Therefore we must be carefully evaluated the multiple traumatic patients for early diagnosis of vascular injury and operate quickly in emergency status.