• Journal of Chest Surgery
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• v.35 no.7
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• pp.556-559
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• 2002

The presense of pectus excavatum in Marfan's syndrome may complicate cardiac operation by making midline sternotomy technically more difficult and limiting the operative exposure of the heart. We operated on a 33 year old male patient with Marfan's syndrome and severe pectus excavatum who had severe mitral regurgitation and moderate aortic regurgitation with 52mm aortic root dilation. The operative field was adequately exposed through a midline sternal incision with two sternal retactors. The patient underwent Bentall operation and mitral valve replacement. The repair of pectus excavatum was performed after completion of CPB and the administration of protamin. Permanent internal stabilization achieved by overlapping of the ends of lower ribs and reinforced with sternal closure wire.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1132-1135
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• 1997

We have experienced two cases of coronary revascularization without extracorporeal circulation in a 63 year old female patient and a 75 year old male patient. The first patient had the lesion which was the nearly total occulusion of mid-LAD, about 90% luminal narrowing of second diagonal branch and less than 50% stenosis of proximal RCA. The other male patient had a single vessel disease involving about 95% stenosis of proximal LAD and 1st diagonal branch. PTCA failed in the irst patient because of relatively long sinus pause during procedure In both of the patients, the coronary revascularizations were done at distal LAD and diagonal branch using left internal mammary artery and saphenous vein graft under the beating state, respectively. The postoperative courses were uneventful and the patients were discharged without any complications.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.964-967
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• 2001

Giant thymic Hyperplasia is a rare lesion in children. We report a case of giant thymic hyperplasia in the right anterior mediastinum in a 2 year-old male patient. Presenting symptom was frequent cough and sputum, plain chest X-ray and computed tomography showed huge mass in the right anterior mediastinum. The tumor resection was done through a median sternotomy for the prevention of progression to atelectasis caused by mass effect and tissue diagnosis. An open biopsy specimen showed normal thymic architecture. The patient recovered without any problem and is doing well untill now. We report this rare case of giant thymic hyperplasia with review of the literature.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.53-57
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• 1999

We describe a case of successful extracorporeal membrane oxygenation(ECMO) in a small infant with cardiopulmonary resuscitation(CPR) failure after an open heart surgery. A 35-day-old male infant weighing 4.4 kg who had congestive heart failure and pulmonary hypertension underwent patch closure of ventricular septal defect without any intraoperative event. Postoperative course was unremarkable in the intensive care uint for about 5 hours before the junctional ectopic tachycardia developed. Sudden cardiac decompensation with bradycardia occurred about 50 minutes after the development of junctional ectopic tachycardia. He was put on ECMO by arterial cannulation at the ascending aorta and by venous cannulation at the right atrial appendage after 4 hours' CPR. The hemodynamics were stable with enough urine output during ECMO. He was weaned from ECMO 38.5 hours after initiation. Delayed sternal closure was attempted. He was extubated on postoperative day 7 and discharged home on postoperative day 21 without any neurologic sequelae.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.583-589
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• 2003

With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. Material and Method: From March 200f to March 2003 at the depart-ment of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, post-operative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. Result: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardio-pulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p< 0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p< 0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). Conclusion: Contamination of pa-tients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.

• 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.23 no.4
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• pp.720-730
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• 1990

The complicated pulmonary emphysema including “Giant bullae” and spontaneous pneumothorax often involve both lungs, and controversy exists concerning which is the more rational means of surgical treatment-bilateral simultaneous operation or two staged operation. We report three cases of the complicated bilateral bullous emphysema and two cases of bilateral spontaneous pneumothorax treated through median sternotomy. We performed the ligation of bullae, bullectomy, cystectomy, wedge resection, and left lower lobectomy through median sternotomy. No technical problems were encountered through this approach, which provided maximum benefit with one operation In conclusions, median sternotomy may be appropriate for resection of emphysematous bullae, specially in a severe COPD patient who may be poorly tolerated the superimposed loss of respiratory function due to incisional pain, because median sternotomy permit bilateral exploration, minimal impairment of pulmonary function, simultaneous restoration of pulmonary function, less incisional pain than routine lateral thoracotomy.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.397-401
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• 2002

The combination of interrupted aortic arch and aortopulmonary window is a rare presentation of congenital heart disease, which requires early diagnosis and surgical treatment. We describe a successful one-stage repair of the anomaly through median sternotomy in a 10-day-old neonate weighing 2.46 kg.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.528-533
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• 1986

Total anomalous pulmonary venous connection is relatively rare cyanotic congenital heart diaease, which represents 1-4% of all congenital cardiac defects. Generally in the majority cases, severe heart failure and cyanosis develops in the early infancy. Because of high mortality in the untreated infants and surgical risk, there are still many things to be improved. Two patients with total anomalous pulmonary venous connection are presented, which we recently experienced. The one was 10 year old female with supracardiac type drained through left innominate vein, and survived the operation and continuous to do well for 1 year. The other 5 year old female with mixed type (right pulmonary vein drained via coronary sinus and left pulmonary vein through left innominate vein) was operated successfully under hypothermia and extracorporeal circulation, and followed up for 6 months without problem. It was very rare case in the literature.

• 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.