Endovascular repair for thoracic aortic aneurysm is widespread and recently, the advent of new device-fenestrated stent graft enables endovascular repair for aortic aneurysm to be close or involved in the orifice of left subclavian artery. However, fenestrated stent graft is not available in Korea. We report herein a case in which endovascular repair for thoracic aortic aneurysm closed to the orifice of left subclavian artery using custom made fenestrated stent graft. The aneurysm was successfully repaired by a total endovascular approach without open surgical repair.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Korea ; Stents ; Subclavian Artery ; Transplants

Intramural esophageal dissection (IED) is an uncommon disorder characterized by separation of the mucosal and submucosal layers of the esophagus. Iatrogenic intervention is the most common cause of IED, but spontaneous dissection is rare. We report an unusually complicated case of spontaneous IED that involved the full-length of the esophagus that necessitated surgical intervention due to infection of the false lumen. In this case, chest computed tomography successfully established the diagnosis and aided in pre-operative evaluation with the use of various image post-processing techniques.
Esophageal Diseases/*radiography/*surgery ; Esophagoscopy/methods ; Esophagus/injuries/radiography ; Humans ; Male ; Middle Aged ; *Multidetector Computed Tomography ; Rare Diseases/*radiography/*surgery ; Rupture, Spontaneous/radiography/surgery

A 50-year-old male visited the emergency room due to the cervical edema caused by a traffic accident. At the cervial CT, diagnosis was confirmed as extensive cervical subcutaneous emphysema secondary to tracheal laceration as a thyroid cartilage fracture. The patient showed loss of symptom after conservative treatment. Thyroid cartilage fracture is rare and tracheal laceration as a result of thyroid cartilage fracture has never been reported in the literatures. Thus we herein report this one case.
Accidents, Traffic ; Diagnosis ; Edema ; Emergency Service, Hospital ; Emphysema ; Humans ; Lacerations* ; Male ; Middle Aged ; Subcutaneous Emphysema ; Thyroid Cartilage* ; Thyroid Gland*

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Cells ; Blood Pressure ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Extracorporeal Circulation ; Heart-Lung Machine ; Humans ; Hypertension ; Infarction ; Lung Diseases, Obstructive ; Mortality ; Perfusion* ; Plasma ; Pulsatile Flow ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Transplants ; Ventilators, Mechanical

Mechanical ventilation is usually the treatment of choice for severe respiratory failure associated with trauma. However, in case of severe hypoxia, mechanical ventilation may not be sufficient for gas exchange in lungs. Patients with Acute Respiratory Distress Syndrome (ARDS) undergo difficulties in oxygen and carbon dioxide exchange. Extracorporeal Membrane Oxygenation (ECMO) is the ideal therapeutic option for those patients with severe traumatic injuries. ECMO allows lungs to reserve their functions and decreases further lung injuries while increasing survival rate at the same time. We report two cases of patients with traumatic ARDS and Multiple Organ Failure including compromised heart function. The preservation of lung function was successful using ECMO therapy.
Anoxia ; Carbon Dioxide ; Extracorporeal Membrane Oxygenation ; Heart ; Humans ; Lung ; Lung Injury ; Multiple Organ Failure ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Survival Rate

Mechanical ventilation is usually the treatment of choice for severe respiratory failure associated with trauma. However, in case of severe hypoxia, mechanical ventilation may not be sufficient for gas exchange in lungs. Patients with Acute Respiratory Distress Syndrome (ARDS) undergo difficulties in oxygen and carbon dioxide exchange. Extracorporeal Membrane Oxygenation (ECMO) is the ideal therapeutic option for those patients with severe traumatic injuries. ECMO allows lungs to reserve their functions and decreases further lung injuries while increasing survival rate at the same time. We report two cases of patients with traumatic ARDS and Multiple Organ Failure including compromised heart function. The preservation of lung function was successful using ECMO therapy.
Anoxia ; Carbon Dioxide ; Extracorporeal Membrane Oxygenation ; Heart ; Humans ; Lung ; Lung Injury ; Multiple Organ Failure ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Survival Rate

BACKGROUND AND OBJECTIVES: Video-Assisted Thoracoscopic surgery for Patent Ductus Arteriosus is an efficient method to reduce the risk of postoperative residual shunt as well as various complications that can be caused by a thoracotomy. The aim of this study was to analyze the safety and efficacy of ductus arteriosus clipping, using videothoracoscopy in sixty-five patients, and the results and prognosis of the operations. SUBJECTS AND METHODS: After general anesthesia of the sixty-five Patent Ductus Arteriosus (PDA) patients, double skin incisions of 7 and 5 mm were made and a thoracoscope inserted at the point of the 5 mm skin incision, with clipping of ductus arteriosus using the 7 mm skin incision were conducted. During the procedure, the tidal volume was kept at the minimum level to maintain O2 saturation, without insertion of a chest tube. RESULTS: There have been reported complications in fourteenth cases, with four of these caused by injury to the recurrent laryngeal nerve; however, they recovered after two weeks, with the other ten receiving a remnant residual shunt. Nine of ten residual shunt cases cured naturally after about six months, with no special treatments. CONCLUSION: Surgery using Video-Assisted thoracoscopic surgery for the PDA patients can decrease the complications due to a thoracotomy, and is therefore, a much safer and more effective method than other existing solutions.
Anesthesia, General ; Chest Tubes ; Ductus Arteriosus ; Ductus Arteriosus, Patent* ; Humans ; Prognosis ; Recurrent Laryngeal Nerve ; Skin ; Surgical Instruments ; Thoracic Surgery, Video-Assisted* ; Thoracoscopes ; Thoracotomy ; Tidal Volume

BACKGROUND: This study assessed the early results of endovascular repair of acute type B aortic dissection and the aortic wall changes following endovascular repair. MATERIAL AND METHOD: From July 2008 to May 2009, the preoperative and follow-up computed tomography (CT) scans of 5 patients with acute type B aortic dissection were evaluated, and these patients had underwent stent graft implantation within 13 days of the onset of dissection (mean: 7 days; range: 3~13). The whole lumen (WL), true lumen (TL) and false lumen (FL) diameters were measured at the proximal (p), middle (m) and distal (d) third of the descending thoracic aorta. RESULT: The study included four men and one woman with an average age of 59.4+/-20.1 years (age range: 37~79 years). The follow-up CT was performed and evaluated at 7 days and 6 months. The primary tear was completely sealed in all the patients. No paraplegia, paresis or peripheral ischemia occurred and none of the patients died. No endoleaks developed in any of the patients during follow-up. The TL diameters increased from 20.4 to 33.5 mm in the proximal third (p/3), from 19.5 to 29.8 mm in the middle third (m/3) and from 15.2 to 23.5 mm in the distal third (d/3). The FL diameters decreased from 18.7 to 0 mm in the p/3, from 15.4 to 0 mm in the m/3 and from 21.4 to 8.7 mm in the d/3. The changes in the TL diameter were statistically significant in the middle and distal aorta, and those changes in the FL diameter were not statistically significant. There was a decrease in the WL after repair, but this was not statistically significant. In three patients, the false lumen disappeared completely on follow-up CT at 6 months. Two patients had patent false lumens and no thrombosis. CONCLUSION: The early results showed that endovascular repair was effective in treating acute type B aortic dissection, and endovascular repair promoted positive aortic wall changes.
Aorta ; Aorta, Thoracic ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Paraplegia ; Paresis ; Stents ; Transplants

An aortoesophageal fistula (AEF) is an extremely rare, potentially fatal condition, and aortic surgery is usually performed together with extracorporeal circulation. However, this surgical method has a high rate of surgical complications and mortality. This report describes an AEF caused by tuberculous esophagitis that was treated successfully using a two-stage operation. A 52-yr-old man was admitted to the hospital with severe hematemesis and syncope. Based on the computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and initially underwent thoracic endovascular aortic repair. Esophageal reconstruction was performed after controlling the mediastinal inflammation. The patient suffered postoperative anastomotic leakage, which was treated by an endoscopic procedure, and the patient was discharged without any further problems. The patient received 9 months of anti-tuberculosis treatment after he was diagnosed with histologically confirmed tuberculous esophagitis; subsequently, he was followed as an outpatient and has had no recurrence of the tuberculosis or any further issues.
Aortic Diseases/etiology/*surgery ; Eosinophilic Esophagitis/*complications/*surgery ; Esophageal Fistula/etiology/*surgery ; Esophagoscopy/*methods ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Tuberculosis/*complications/surgery ; Vascular Surgical Procedures/methods

The surgical treatments for aortic arch aneurysm are thought to be very invasive procedures, and high morbidity and mortality rates have been reported after aortic arch aneurysm operations. Many surgeons currently prefer the insertion of a stent-graft rather than an operation for treating an aortic arch aneurysm and if needed, with bypass of the subclavian or carotid arteries, which is called the 'hybrid method'. We managed one patient with an aortic arch aneurysm by using the hybrid method, and so we report on this case with a review of the relevant literature.
Aneurysm ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Carotid Arteries ; Chimera ; Humans ; Stents