흉부대동맥궁 박리증 수술 전, 후 발생한 폐렴 및폐부종에 대한 심폐호흡물리치료 임상사례

류흥호(Hung-Ho Ryou),김호봉(Ho-Bong Kim) 대한심장호흡물리치료학회 2016 대한심장호흡물리치료학회지 Vol.4 No.1

Purpose : The purpose of this case study is find out the effect of the cardiorespiratory physical therapy on a pneumonia and pulmonary edema of thoracic aortic-arch dissection patient before and after surgery. Methods : The thoracic aortic-arch dissection patient taken a pneumonia and pulmonary edema was performed cardiorespiratory physical therapy that coughing assist, tapping, deep breathing exercise, chest mobilization and aerobic exercise(bicycle) for 4days. Result : The thoracic aortic-arch dissection patient taken a pneumonia and pulmonary edema having a dyspnea, high-fever, lot of sputum and general deconditioning is improved by the cardiorespiratory physical therapy for 4days. A dyspnea, high-fever, lot of sputum of patient subsided and general deconditioning improved, patient s chest x-ray prove cardiorespiratory physical therapy that help restore patient s pneumonia and pulmonary edema. Conclusion : The result of application of cardiorespiratory physical therapy to the pneumonia and pulmonary edema of thoracic aortic-arch dissection patient demonstrate the importance of cardiorespiratory physical therapy in an approach to the pneumonia and pulmonary edema of thoracic aortic-arch dissection patient and treatment intervention.

하행대동맥 및 흉복부 대동맥 수술의 임상적 경험

조광조,우종수,성시찬,최필조 대한흉부외과학회 2002 Journal of Chest Surgery (J Chest Surg) Vol.35 No.8

The Clinical Experience of The Descending Thoracic and Thoracoabdominal Aortic Surgery 배경 : 흉복부 대동맥 질환 수술은 부위에 따라 사용되는 수술법이 다양하며 각 방법마다 장단점이 있어 논란의 대상이 되고 있다. 이에 저자들은 지금까지 여러 방법으로 흉복부 대동맥 질환을 수술한 성적과 위험 요소를 분석하여 보고하고자 한다. 대상 및 방법: 1992년 6월부터 2001년 8월까지 저자들은 36명의 흉복부 대동맥 수술을 시행하였다. 이중 17 명은 대동맥 박리증, 17명은 대동맥류, 1명은 대동맥 축착증에 병발한 대동맥박리증, 1명은 외상성 대동맥손상이었다. 수술은 26례에서 흉부대동맥 치환술을, 10명에서 흉복부 대동맥 치환술을 시행하였다. 흉부대동맥치환술은 11명에서 좌심방대퇴동맥간 centrifugal 펌프을 통한 우회로를 하며 수술하였고, 11명에서 대퇴동정맥 사이에, 4명은 우심방과 상행대동맥 사이에 심폐기를 가동하며 이중 6명은 극저체온순환정지하에 수술을 하였다. 흉복부대동맥 치환술은 6명에서 대퇴동정맥을 통한 심폐기를 가동시키며 수술하였고 3명은 대퇴정맥에 삽관하여 흡입한 혈액을 pump 로 주입하며 수술을 하였고 한 명은 심폐기의 도움없이 수술하였다. 결과 : 수술합병증은 신부전 7례, 간기능부전 11례, 폐혈증 2례, 호흡부전 5례, 심부전 2례, 뇌경색 7례, 허혈성 척추손상 1례 등이 발생되었다. 술 후 원내 사망은 9례로 수술직후 24시간 이내 사망한 경우가 6례로 사망원인은 출혈 2례, 심부전 2례, 신부전 2례 등이었고, 수술 후 1주 뒤 원내 사망은 3례로 패혈증, 호흡부전증, 뇌경색증 등으로 사망하였다. 퇴원 후 만기 사망은 3례로 사인은 원위부 파열로 인한 쇽 와 뇌경색증 폐렴 합병증으로 사망하였다. 결론 : 흉부대동맥치환술을 받은 환자 26명 중 수술사망은 5명이며 이중 3명이 극저체온 순환정지하에 수술을 시행받은 환자들이었다. 흉복부대동맥 치환술을 받은 10명 중 수술사망은 4명이었고 이중 2명이 복부동맥을 같이 광범위하게 치환한 환자들이었다.

비외상성 종격동 및 대동맥질환 : 흉부 단순촬영상의 진단적 가치 Chest Radiographic Findings

김갑득,최영희 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. Rupture of thoracic aortic aneurysm and dissection into the chest space results in the death of the patient from uncontrolled hemorrhage. The purpose of our study is to evaluate chest radiographic findings that may assist in the rapid detection of nontraumatic disorder in mediastinum and thoracic aorta. Material and method. Thirteen consecutive chest radiographs obtained at emergency room of patients with hemorrhage from ruptured thoracic aortic aneurysms or aortic dissections were randomized with radiographs of 8 subjects with nonruptured thoracic aortic aneurysms, 11 subjects with nonruptured aortic dissections, and 20 control subjects. Diagnoses were confirmed by computed tomography(CT) and transesophageal echocardiography(TEE). A retrospective study was performed by assessment of 14 parameters on each of these 52 radiographs to screen the mediastinum and thoracic aortic disorder. Result. significant difference between patients with mediastinum and thoracic aortic disorder(aneurysm and dissection) and normal subjects occurred in mediastinal/chest ratio>0.25, aortic knob width>4cm, tracheal shift to right, loss of paratracheal strip & azygos vein, and left pleural & extrapleural fluid of chest radiographs(p<0.05). The most useful predictors of mediastinum and thoracic aortic disorder were aortic knob widening above 4cm and combining signs of mediastinum/chest ratio above 0.25 and abnormal aortic arch. These plain radiographic signs had a sensitivity of 9.1∼96.9% and a specificity of 40∼100% for mediastinum and thoracic aortic disorder. Conclusion. The chest radiograph obtained at emergency room remains the best available screening test for mediastinum and thoracic aortic disorder and can be used effectively, though not perfectively, to eliminate unneccessary CT or TEE.

대동맥 질환의 진단을 위한 응급경식도 심초음파도의 안전성

오범진,최경훈,김성환,김현,김선만,이승환,윤정한,황성오,이강현,강구현,김옥준 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: Early recognition of thoracic aortic disease is critical to reduce morbidity and mortality. Transesophageal echocardiography(TEE) has recently proved superior to traditional diagnostic modalities such as computed tomogram(CT) scan, aortography and magnetic resonance imaging (MRI) in assessing thoracic aortic diseases because of high sensivity and portability. However, the safety of emergency TEE has never been evaluated i patients with acute aortic disease in the emergency department. The purpose of this study was to evaluate the safety of TEE as an emergency diagnostic procedure to detect thoracic aortic diseases. Method: From May 1994 to July 1996, 25 patients who were suspicious of thoracic aortic disease and underwent TEE as the first diagnostic tool in the emergency department were enrolled. Biplane TEE was used under the administration of low-dose benzodiazepine and phayngeal spray of lidocaine. Airway protection by endotracheal intubation was done if the patient had no gag reflex or unconsciousness. Result: Among the 25 patients including 16 patients with nontraumatic cause and 9 patients with trauma, 18 patients had thoracic aortic diseases on TEE. Three of 9 patients with trauma had aortic injury(an aortic tear, an aortic aneurysm, an aortic subintimal hematoma). Fifteen of 16 patients with nontraumatic cause revealed aortic dissection on TEE. Systolic blood pressure and heart rate were not significantly changed by TEE. There was no complication during TEE in 23 patients(92%). Severe hypertension was noted in a patient and cardiac tamponade from previous pericardial effusion was developed in a patient during TEE. Conclusion: Our observation suggests that TEE is a safe diagnostic modality to detect thoracic aortic diseases in the emergency department.

Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease

( Jong Hyun Choi ),( Sang-pil Kim ),( Han Cheol Lee ),( Tae Sik Park ),( Jong Ha Park ),( Bo Won Kim ),( Jinhee Ahn ),( Jin Sup Park ),( Hye Won Lee ),( Jun-hyok Oh ),( Jung Hyun Choi ),( Kwang Soo Ch 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.0

Background/Aims: Untreated rupture of the thoracic aorta is associated with a high mortality rate. We aimed to review the clinical results of endovascular treatment for ruptured thoracic aortic disease. Methods: We retrospectively reviewed data on 37 patients (mean age, 67.0 ± 15.18 years) treated for ruptured thoracic aortic disease from January 2005 to May 2016. The median follow-up duration was 308 days (interquartile range, 61 to 1,036.5). The primary end-point of the study was the composite of death, secondary intervention, endoleak, and major stroke/paraplegia after endovascular treatment. Results: The etiologies of ruptured thoracic aortic disease were aortic dissection (n = 11, 29.7%), intramural hematoma (n = 7, 18.9%), thoracic aortic aneurysm (n = 14, 37.8%), and traumatic aortic transection (n = 5, 13.5%). Three patients died within 24 hours of thoracic endovascular aortic repair, and one showed type I endoleak. The technical success rate was 89.2% (33/37). The in-hospital mortality rate was 13.5% (5/37); no deaths occurred during follow-up. The composite outcome rate during follow-up was 37.8% (14/37), comprising death (n = 5, 13.5%), secondary intervention (n = 5, 13.5%), endoleak (n = 5, 13.5%), and major stroke/paraplegia (n = 3, 8.1%). Left subclavian artery revascularization and proximal landing zone were not associated with the composite outcome. Low mean arterial pressure (MAP; ≤ 60 mmHg, [hazard ratio, 13.018; 95% confidence interval, 2.435 to 69.583, p = 0.003]) was the most significant predictor and high transfusion requirement in the first 24 hours was associated with event-free survival (log rank p = 0.018). Conclusions: Endovascular treatment achieves high technical success rates and acceptable clinical outcome. High transfusion volume and low MAP were associated with poor clinical outcomes.

흉부 외상 환자에서 경식도 심초음파에 의한 대동맥 손상 진단의 유용성

안희철 ( Hee Cheol Ahn ),오성범 ( Sung Bum Oh ),김호중 ( Ho Jung Kim ),김현 ( Hyun Kim ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ),김헌주 ( Hun Joo Kim ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: Early recognition of thoracic aortic disease is critical to reduce morbidity and mortality. The accuracy and safety of TEE in trauma patients has recently challenged to traditional diagnostic modality for assessing thoracic aortic disease such as computed tomogram (CT) scan, aortography, and magnetic resonance imaging (MRI). The purpose of this study was to evaluate the utility of TEE as an emergency diagnostic procedure for detection of thoracic aortic injury in trauma patients. Methods: From March 1998 to October 2002, 21 traumatic patients who had a suspicious of thoracic aortic injury and underwent TEE as the first diagnostic tool in the emergency department were enrolled. Indications of TEE in the suspicious thoracic aortic disease were typical chest pain, mediastinal widening or massive left side hemothorax. Results: There was no complication during TEE or post procedure of TEE in all patients. The findings of TEE were as followings: aortic dissection was 9 cases (43%), periaortic hematoma was 5 cases (24%), and aortic rupture, aneurysm, intramural hematoma, RA rupture, cardiac tamponade, and both hemothorax was 1 case in each other. The open thoracotomy on 11 patients were performed and emergency department thoracotomy on 2 patients were performed. Ten patients were performed conservative management. Conclusion: We suggest that TEE is a useful and safe diagnostic modality to detect thoracic aortic injury in hemodynamically unstable patient after trauma.

Successful Treatment of a Ruptured Aortic Arch Aneurysm Using a Hybrid Procedure

최보경,이한철,이혜원,박진섭,오준혁,김상필,차광수 대한심장학회 2011 Korean Circulation Journal Vol.41 No.8

Aortic rupture has a high mortality rate and can be considered a medical emergency. The standard treatment for aortic rupture is surgical repair. An aortic stent graft for a ruptured descending aorta is considered an effective alternative treatment. However, an aortic stent graft is difficult when the aortic aneurysm is in the aortic arch due to supra-aortic vessels. We report on a patient with a ruptured aortic arch aneurysm treated with a hybrid procedure, which involved a carotid to carotid bypass operation and an aortic stent graft. A 71-year-old male patient visited our cardiovascular center suffering from hemoptysis. The chest CT and aortography showed a 9 cm sized aortic arch aneurysm 0.5 cm distal to the left subclavian artery and a hemothorax in the left lung. The patient refused to undergo a full open operation. We performed a carotid to carotid bypass in advance, and two pieces of aortic stent grafts were placed across the left carotid artery and left subclavian artery. The follow up CT showed the aortic stent grafts, no endoleaks and no thrombus in the aortic arch aneurysm. The patient was discharged from the hospital without complication.

Simultaneous Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm Combined with Saccular Thoracic Aortic Aneurysm

Minju Kim,Jeong Hee Han,Dae Hwan Kim,Myunghee Yoon,Hyuk Jae Jung 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.3

With the recent increase in imaging tests, coexisting abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) are being discovered accidentally. We report two cases of simultaneous endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) for AAA and TAA. Both 74-year-old and 79-year-old male with infrarenal AAA and saccular TAA were treated simultaneously with EVAR and TEVAR. Saccular TAAs were identified in the upper thoracic aorta during the evaluation of AAA. During endograft placement, carotid-subclavian bypass and cerebrospinal fluid (CSF) drainage were performed. Both patients were successfully discharged without spinal cord ischemia. Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. Moreover, CSF drainage may be necessary to protect the spinal cord.

Clinical Midterm Results of Surgical Aortic Valve Replacement with Sutureless Valves

Soonchang Hong,Jung-Woo Son,Yungjin Yoon The Korean Society for Thoracic and Cardiovascular 2024 Journal of Chest Surgery (J Chest Surg) Vol.57 No.3

Background: Sutureless aortic valves may enable shorter procedure times, which benefits patients with elevated surgical risk. We describe the outcomes of patients with aortic stenosis who underwent aortic valve replacement (AVR) using the sutureless Perceval aortic bioprosthesis. Methods: Data from a retrospective cohort were obtained from a clinical database. The study enrolled patients with symptomatic severe aortic stenosis who underwent surgical AVR with a sutureless bioprosthesis between August 2015 and December 2020. In total, 113 patients were included (mean age, 75.3±8.4 years; 57.5% women; median Society of Thoracic Surgeons score, 9.7%; mean follow-up period, 51.19±20.6 months). Of these patients, 41 were octogenarians (36.2%) and 3 were nonagenarians (2.6%). Transthoracic echocardiography was employed to assess changes in ejection fraction (EF), left ventricular mass index (LVMI), and mean pressure gradient (MPG). Results: The in-hospital mortality rate was 2.6%, and 13 patients developed new-onset atrial fibrillation. A permanent pacemaker was implanted in 3 patients (2.6%). The median intensive care unit stay was 1 day (interquartile range [IQR], 1-2 days), and the median hospital stay was 12 days (IQR, 9.5-15 days). The overall survival rate at 5 years was 95.9%. LVMI and MPG were reduced postoperatively, while EF increased over the follow-up period. No structural valve deterioration was observed, and no meaningful paravalvular leakage developed during follow-up. Conclusion: The use of a sutureless valve in the aortic position is safe and feasible, even for high-risk elderly patients requiring surgical AVR. LVMI and MPG decreased postoperatively, while EF increased over the follow-up period.

흉부 대동맥확장증의 비중재치료 및 정기적인 검사

최승혁 ( Seung Hyuk Choi ) 대한내과학회 2015 대한내과학회지 Vol.89 No.4

Thoracic aortic enlargement is a silent, but deadly, disease that is often diagnosed on imaging studies performed for unrelated indications and result in life threatening event such as aortic rupture and dissection. The etiologies underlying thoracic aortic enlargement are diverse and can range from degenerative or hypertensive aortic enlargement to more rare genetic disorders including Marfan syndrome and Loeys-Dietz syndrome. Therefore, the diagnosis and management of this disease can be complex. This review focuses on the periodic surveillance using imaging modality before surgical intervention and medical management of asymptomatic patients with thoracic aortic aneurysm. (Korean J Med 2015;89:377-380)