The Clinical Experience of the Aortic Arch Replacement in Acute Type A Aortic Dissection / 대한흉부외과학회지

BACKGROUND: The aortic arch replacement in an acute aortic dissection is technically demanding procedure that has a lot of postoperative morbidity and high mortality. The authors have applied several techniques of aortic arch replacement to overcome the risks of the procedure. Therefore we analysed the results of these techniques. MATERIAL AND METHOD: From March of 1996 to July of 2002, we performed 31 cases of the aortic arch replacement in the Stanford type A acute aortic dissection. There were 12 male and 19 female patients with 59.6+/-9.4 years of mean age. Among them 18 cases were treated with the hemiarch replacement and 13 cases with the total arch replacement. We approached the aortic arch through median sternotomy in all but 3 cases of Clamshell incision and applied the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The associated procedures were 2 Bentall's procedures, an axillobifemoral bypass, a femorofemoral bypass and a carotid artery bypass. RESULT: The postoperative morbidities were 8 acute renal failures, 3 CNS complications, 2 low cardiac output syndromes, 2 malperfusion syndromes, and 2 deep wound infections. There were 4 cases of early hospital mortality which were from an acute renal failure, a postoperative bleeding, a low cardiac output syndrome, and a reperfusion syndrome. There were 3 cases of late hospital mortality which were from an acute renal failure, and 2 multiorgan failures. So the total mortality rate was 22.5%. There were 4 cases of late mortality after the discharge, which were form 2 cases of distal anastomotic rupture and 2 cases of intracranial hemorrhage. CONCLUSION: The hemiarch replacement has relatively shorter operative time and lower hospital mortality but higher late mortality than the total arch replacement. The total arch replacement needs more technically demanding procedure.

Acute Type A Aortic Dissection Mimicking Penetrating Atherosclerotic Ulcer / 대한흉부외과학회지

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiography with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, hemopericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

One-Stage Ascending, Arch, and Descending Thoracic Aorta Replacement Through Median Sternotomy / 대한흉부외과학회지

In patient with severe adhesion between lung and aorta, there is some limitation in approaching the distal arch or descending thoracic aorta through the usual left thoracotomy. We report a case of a successfully managed distal arch and descending thoracic aortic aneurysm through the median sternotomy without any manipulations of the lung in a 66 year old man who presented hemoptysis.

MINI-TRAUMATIC ENDOVASCULAR THERAPY FOR STANFORD B AORTIC DISSECTION / 解放军医学杂志

This paper is to summarize our experiences in the operation indication and management of perioperative complications in treatment of Stanford B aortic dissection by using endovascular graft exclusion (EVGE). 32 patients underwent the procedure of EVGE . Various sizes of tubular grafts were introduced over the entry tear of aorta via the femoral artery. The procedure was technically successful in all patients. No Severe complication occurred during the perioperative period except one death due to heart infarction. These preliminary results suggest that EVGE is safe and efficient for Stanford B aortic dissection. EVGE is a method of first choice for the patients with this disease.

DIAGNOSIS AND TREATMENT OF STANFORD B THORACIC AORTIC DISSECTION COMPLICATED WITH RENAL ISCHEMIA / 解放军医学杂志

To investigate the diagnosis and treatment of Stanford B thoracic aortic dissection eomplicated with renal ischemia, 29 cases of Stanford B thoracic aortic dissection admitted from January 1996 to April 2000 were retrospectively studied. Three of them had renal ischemia secondary to aortic dissection (2 acute,1 chronic). One patient in acute stage died 3 days after onset, the other patient in acute stage complicated with bilateral lower extremity ischemia was treated with fenestration of intimal flap, and the symptom was relieved. The patient in chronic stage was treated with endovascular graft exclusion for aortic dissection and the renal ischemia was relieved because of the restored true lumen blood. The results showed that palliative bypass helps relieve symptoms and improve survival rate. For the chronic aortic dissection complicated with renal ischemia, endovascular graft exclusion can restore the true lumen blood and relieve renal ischemia.

One-stage Replacement of the Total Thoracic Aorta / 대한흉부외과학회지

Some extensive thoracic aortic aneurysms are not amenable to staged repair, such as extremely large distal aortic aneurysms that are unsuitable for an elephant trunk anastomosis, or aneurysms that are accompanied by complications such as ruptured descending thoracic aneurysm. We report here a case of successful replacement of the aorta from the ascending to the descending aorta in one operation. The patient was 65-year-old man who had an aneurysm which involved the entire thoracic aorta and ruptured in the descending aorta. The operation was performed via transverse thoracosternotomy, and under the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The patient recovered uneventfully and was discharged without any neurologic complications.