Extra-anatomic Bypass Grafting after Endovascular Embolization for the Treatment of Mycotic Aneurysm: 2 case reports

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.

A Case of Coarctation of the Aorta Diagnosed by Tardus-Parvus Renal Doppler Flow Patterns

No abstract available.

N-Terminal Pro-B-type Natriuretic Peptide Is Useful to Predict Cardiac Complications Following Lung Resection Surgery

BACKGROUND: Cardiovascular complications are major causes of morbidity and mortality following non-cardiac thoracic operations. Recent studies have demonstrated that elevation of N-Terminal Pro-B-type natriuretic peptide (NT-proBNP) levels can predict cardiac complications following non-cardiac major surgery as well as cardiac surgery. However, there is little information on the correlation between lung resection surgery and NT-proBNP levels. We evaluated the role of NT-proBNP as a potential marker for the risk stratification of cardiac complications following lung resection surgery. MATERIAL AND METHODS: Prospectively collected data of 98 patients, who underwent elective lung resection from August 2007 to February 2008, were analyzed. Postoperative adverse cardiac events were categorized as myocardial injury, ECG evidence of ischemia or arrhythmia, heart failure, or cardiac death. RESULTS: Postoperative cardiac complications were documented in 9 patients (9/98, 9.2%): Atrial fibrillation in 3, ECG-evidenced ischemia in 2 and heart failure in 4. Preoperative median NT-proBNP levels was significantly higher in patients who developed postoperative cardiac complications than in the rest (200.2 ng/L versus 45.0 ng/L, p=0.009). NT-proBNP levels predicted adverse cardiac events with an area under the receiver operating characteristic curve of 0.76 [95% confidence interval (CI) 0.545~0.988, p=0.01]. A preoperative NT-proBNP value of 160 ng/L was found to be the best cut-off value for detecting postoperative cardiac complication with a positive predictive value of 0.857 and a negative predictive value of 0.978. Other factors related to cardiac complications by univariate analysis were a higher American Society of Anesthesiologists grade, a higher NYHA functional class and a history of hypertension. In multivariate analysis, however, high preoperative NT-proBNP level (>160 ng/L) only remained significant. CONCLUSION: An elevated preoperative NT-proBNP level is identified as an independent predictor of cardiac complications following lung resection surgery.

Clinical Features and Treatment of Cervical Tuberculous Lymphadenitis / 대한흉부외과학회지

BACKGROUND: Cervical tuberculous lymphadenitis is the most common form of peripheral tuberculous lymphadenitis. The American Thoracic Society recommends 6 months of isoniazid, rifampin, ethambutol and pyrazinamide for treatment of peripheral tuberculous lymphadenitis, but even with this recommended treatment, frequent relapse occurs in actual clinical situations. MATERIAL AND METHOD: The medical records of 38 patients diagnosed and treated for cervical tuberculous lymphadenitis between February 1997 and February 2007 were retrospectively reviewed. RESULT: The study included 14 males (36.8%) and 24 females (63.2%), with a mean age of 36.9+/-16.3 years. The most frequent symptom was palpable neck mass in 24 patients (63.2%); 10 patients (26.3%) complained of fever or chills. Only nine patients (23.7%) had radiologic abnormalities. All patients received anti-tuberculous medications for at least 7 months, with isoniazid, rifampin, ethambutol and pyrazinamide for the first 2 months, and then isoniazid, rifampin and ethambutol given for more than 5 months. Relapse occurred in 7 patients (21.2%). CONCLUSION: Since many patients with cervical tuberculous lymphadenitis have no symptoms and show no radiologic abnormalities, diagnosis and treatment tend to be delayed. Considering the high relapse rate, the anti-tuberculous medication period should be longer than 6 months and this is recommended by the American Thoracic Society.

A Case Report on Redo Lung Transplantation for Treating Chronic Pulmonary Graft Rejection / 대한흉부외과학회지

A 43 year-old female, who underwent bilateral lung transplantation for Eisenmenger syndrome 10 years previously, visited our hospital complaining of progressive severe dyspnea. She was diagnosed as having bronchiolitis obliterans syndrome, which was presumably caused by chronic graft rejection following lung transplantation. Due to the aggravated dyspnea despite medical treatment, she required ventilator care and then she underwent lung retransplantation. We report here on a case of lung retransplantation for treating chronic graft rejection following the previous lung transplantation for the first time in Korea.

Early and Midterm Results of Hybrid Endovascular Repair for Thoracic Aortic Disease / 대한흉부외과학회지

BACKGROUND: A hybrid procedure using an open surgical extra-anatomic bypass of aortic arch vessels and thoracic endovascular aortic repair (TEVAR) is less invasive than open surgery, and provides a suitable proximal landing zone. Here we report our experience with a hybrid TEVAR procedure at a single center. MATERIAL AND METHOD: We retrospectively reviewed consecutive patients with thoracic aortic disease who received a hybrid TEVAR procedure between August 2008 and January 2010. Patients' data were prospectively collected and mean follow-up was 10.8+/-5.5 months (range 3~20). RESULT: Nine patients (7 males and 2 females) with a mean age of 63.8+/-15.8 years (range 38~84) underwent a hybrid procedure. Five patients had an arch or a proximal descending aortic aneurysm, two had a dissecting aneurysm of the descending aorta, and two had an aneurysm of the ascending arch and descending aorta. Mean expected mortality calculated by logistic EuroSCORE was 21%. Six patients underwent debranching and rerouting from ascending aorta to arch vessels, 2 had carotid-carotid bypass grafting, and 1 underwent carotid-axillary bypass grafting. Mean operation time was 221.4+/-84.0 min (range 94~364). Deployment success of endovascular stent grafting was 100% with no endoleak on completion angiography. There was no mortality, and a small embolism in the branch of the right opthalmic artery in one patient. During follow-up, one intervention was required for the endoleak. Actuarial survival at 20 months was 100%. CONCLUSION: Early and mid-term results are encouraging and suggest that hybrid TEVAR procedures are less invasive and safer and represent an effective technique for treating thoracic aortic disease.

Hybrid Endovascular Repair for Type I Endoleak after Stent Grafting of Chronic Stanford Type B Aortic Dissection: A case report / 대한흉부외과학회지

A 67 years old male patient was admitted with back pain that had recurred from 6 months previously. Eleven years previously, he underwent stent grafting at the descending thoracic aorta for a chronic Stanford type B aortic dissection. The preoperative computed tomography showed aortic dissection from the origin of the left subclavian artery to the bifurcation of the abdominal aorta, and there was a type I endoleak at the proximal portion of the stent graft and aneurysmal dilatation of the descending aorta. A hybrid endovascular repair was successfully performed, and this involved debranching and rerouting the aortic arch vessels under extracorporeal cardiopulmonary bypass and then this was followed 13 days later by stenting in the ascending aorta, the aortic arch and the descending aorta. The postoperative computed tomography showed complete exclusion of the type I endoleak. After discharge, he has been followed up for 8 months without any problems.

Glomus Tumor of the Trachea : A case report / 대한흉부외과학회지

Glomus tumor is a distinctive type of perivascular tumor whose cell type is a modified smooth cell that closely resembles the glomus body, and this is where the tumor's name is derived. This kind of neoplasm is a benign and rather uncommon neoplasm that can be found in any part of the body, yet it is most commonly seen in the subungual area. Glomus tumor of the trachea is extremely rare. We present the clinicopathologic findings of a resected glomus tumor of the trachea along with a review of the related literature.

Nonocclusive Mesenteric Ischemia That Developed during Redo-doubleValve Replacement Surgery, and This Was Caused by Acute Aortic Dissection / 대한흉부외과학회지

Nonocclusive mesenteric ischemia (NOMI) is a rare complication that occurs in about 0.05% of patients after open- heart surgery, and NOMI refers to the mesenteric ischemia that's caused by splanchnic vasospasm without occlusion of the great intestinal vessels. In the presently reported case, NOMI developed to maintain the blood flow to the heart and brain after several minutes of a hypotensive status and the latter was caused by acute aortic dissection that complicated an aortic cannulation procedure. Unfortunately, the patient died even though the problems were diagnosed early and proper treatment was administered. Early diagnosis of NOMI by angiography and the selective infusion of vasodilators are thought to be the only way to improve survival for patients with clinically suspected NOMI.