• Journal of Chest Surgery
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• v.34 no.10
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• pp.784-786
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• 2001

We at Keimyung University Dongsan Medical Center experienced simultaneous repair of pectus excavatum and secundum atrial septal defect We used resection deformed perichondrium, raising sternum at right angle to secure good operative field for open heart surgery. Mechanical ventilation was applied which could be weaned on postoperative 2 hours. The hospital course was uneventful without any other sequale. The patient was discharged on postoperative day 6.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.609-612
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• 2004

Even though the Cox-Maze III procedure is the gold standard in the therapy for atrial fibrillation (AF) and its outcome is excellent, the complexity of the operation, longer cardiopulmonary bypass time and the risk of bleeding have tended to dissuade cardiac surgeons from its application. The recent data of the pathogenesis of AF and the development of alternative energy sources have facilitated the development of the modified Cox-Maze procedure rapidly. We reported that atrial fibrillation was conversed to sinus rhythm by the epicardial microwave ablation without cardiopulmonary bypass and the normal sinus rhythm was observed during 33 months of follow-up period.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.368-372
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• 1999

Background: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. Material and Method: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. Result: The proportion of the skin incision length to the sternal length was 63.1${\pm}$3.9%(5.2∼11cm, mean 7.3cm) in children, and 55.0${\pm}$3.5%(10∼13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. Conclusion: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.568-572
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• 2008

Background: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. Material and Method: Fifteen patients were analyzed. Their mean age was $31{\pm}6$ years. The mean ASD size was $24{\pm}5mm$ and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a $4{\sim}5cm$ inframammary skin incision, CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were $160{\pm}47\;and\;70{\pm}26 $minutes, respectively. Result: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was $5.9{\pm}1.8$ days. The mean follow-up duration was $10.7{\pm}6.4$ months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. Conclusion: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.214-220
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• 2005

Extended transseptal approach can provide an excellent view of the mitral valve but the safety of this approach is controversial because this incision requires transaction of the sinus node artery, which in most cases and can result postoperative arrhythmia. The purpose of this study was to evaluate perioperative and longterm conduction disturbances and the cardiac rhythms of patients who underwent an extended transseptal approach for mitral valve surgery. Material and Method: Postoperative cardiac rhythms were analyzed in the 164 consecutive patients who received mitral valve replacements with a extended transseptal approach between March 1992 and July 2003. Result: Of the 84 patients in normal sinus rhythm, 34 ($39\%$) had developed transient junctional rhythm and atrial fibrillation after operation, lasting less than 72 hours in most of cases. No intractable arrhythmias occurred. Most of these arrhythmia were not detected at the time of discharge and only 8 patients ($9\%$) had atrial fibrillation at discharge. Postoperative PR intervals increased for 1 week, then decreased within 2 weeks postoperatively, and returned to normal range by 6 months postoperatively. During the postoperative period, 4 of the 78 patients with preoperative atrial fibrillation developed normal sinus thythm. Conclusion: The post-operative arrhythmias were temporary and showed no significant complications after extended transseptal approach for the mitral valve surgery.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.421-423
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• 2010

A 52-year-old female presented with pain and swelling owing to recurrent inflammation on a generator pocket. She had undergone a permanent pacemaker implantation (DDD type) 7 years previously. We planned to insert a new pacemaker after removal of the previous generator and wires through a surgical approach. However, she had a history of the left modified radical mastectomy (MRM) with radiation therapy for breast cancer. For this patient, it would be difficult to care for the postoperative wound if we approached via the median sternotomy. Therefore, we decided to use a right atrial approach via a right thoracotomy. We removed the previous pacing wires through an atriotomy and inserted a new pacemaker using epicardial pacing leads without cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.311-314
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• 1996

Eighteen patients (13 female and ave male) aged from 15 to 62 years (mean age 42.6 years) underwent excision of cardiac myxoma(17 left atrial, one right atrial) between 1985 and 1994 at Pusan National University hospital. All patients complained of exertional dyspnea and most had a few additional symtoms including palpitation, chest pain, syncope, general weakness, weight loss, fever, cough and epigastric disconyort. The diagnosis was made by echocardiography alone in left atrial myxomas but a myxoma in right atrium was diagnosed incidentally during mitral valve replacement for rheumatic valvular heart disease. The tumor attachment sites were fossa ovalis in 13, other interatrial septum in 4, mitral valve annulus in one and free wall of left atrium in two cases. The tumor was excised successfully via right atriotomy in 8 and biatriotomy in 10 cases. There was no hospital nor late death, and no recurrent case during the follow up period. Curative surgical excision of cardiac myxoma can be performed with low morbidity and very low r currence rate.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.161-170
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• 2024

Purpose To assess the safety and feasibility of intentionally positioning the catheter tip in the right atrium (RA) without an abutment during implantation of a totally implantable venous access port (TIVAP). Materials and Methods We enrolled 330 patients who had undergone TIVAP implantation between January and December 2016 and postoperative chest CT. The TIVAP was placed using the single-incision technique to access the axillary vein directly from the incision line. To position the catheter tip in the RA without abutment, blood return was checked before cutting. Catheter length and complications were evaluated by retrospectively reviewing medical images and records. Results All patients achieved successful catheter tip positioning without abutment or dysfunction. The median tip position was 15.3 mm distal to the cavoatrial junction (CAJ) on fluoroscopy and 6 mm distal to the CAJ on CT. Catheter tips migrated a median of 10.4 mm cephalically on CT compared to fluoroscopy. Thromboses were detected in the RA and superior vena cava in one patient each. Conclusion Intentional catheter tip positioning in the RA without abutment is a safe and feasible technique with a low incidence of thrombosis and no observed dysfunction.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.945-950
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• 1996

Twelve patients with left ventricular-right atrial shunt (LV-RA shunt) underwent surgical correction be- tween April 1982 and March 1995. Seven patients were male and five patients were female. Age ranged from 3 to 26 years with mean age of 8.5 years. On the preoperative chest PA views, increased pulmonary vascularity was noted in 3 cases and enlargement of right atrium in 4 cases. The mean preoperative cardiothoracic ratio was 0.59. Echocardiographic studies were obtained in 9 patients and the preoperative echocardiographic diagnoses were LV-RA shunt in 2 cases, ventricular septal defect (VSD) in 6 casei, and atrial septal defect (ASD) in 1 case. The preoperative ngiographic diagnoses which were obtained in all patients were LV-RA shunt in 5 cases, VSD in 5 cases, ASD in 1 case, and VSD with ASD in 1 case. The descriptions of defect of LV-RA shunt according to intraoperative findings were supravalvular defect in 5 cases(42%), infravalvular defect in 4 cases (33%), and combined defect in 3 cases (25%). Associated anomalies of tricuspid valve in 4 cases of infravalvular defect were perforation (3 cases) and cleft (1 case). Primary closure of the septal defect was performed through the right atriotomy in all but one patient. There was no operative death. One patient underwent reoperation because of the residual interventricular shunt. All patients have been in good condition.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.827-830
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• 1999

Congenital left atrial appendage aneurysm is a very rare congenital cardiac abnormality. That is postulated to arise from a developmental weakness in the atrial wall in utero. Clinically, patients are often asymptomatic and are diagnosed incidentally, but supraventricular arrhythmias and systemic thromboembolism have also been reported in some cases. Surgical resection at the time of diagnosis is recommended because of the propensity for thromboembolic complications. A 13-month-old female, who was suspected preoperatively as having partial absence of pericardium with left atrial herniation through the defect, underwent surgical resection of the left atrial appendage aneurysm. Exposure through a median sternotomy showed an intact pericardium. The postoperative course was uneventful.