• Journal of Chest Surgery
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• v.53 no.1
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• pp.28-33
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• 2020

Background: When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. Methods: Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. Results: Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). Conclusion: Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.

• Journal of Chest Surgery
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• v.45 no.3
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• pp.141-147
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• 2012

Background: Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods: A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results: The mean follow-up duration was $4.9{\pm}3.1$ years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of $4.4{\pm}2.5$ years of echocardiographic follow-up (p<0.001). Conclusion: Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.

• Journal of Chest Surgery
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• v.53 no.2
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• pp.53-57
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• 2020

Background: Video-assisted thoracoscopic surgery (VATS) lobectomy has become the major surgical option for the treatment of non-small cell lung cancer (NSCLC). Endoscopic instruments such as stapler cartridges are essential for VATS procedures. In this study, we investigated the factors that affect the number of stapler cartridges used in VATS lobectomy. Methods: A retrospective analysis was conducted of patients who underwent complete VATS lobectomy for NSCLC from January 2013 to December 2015. Results: In total, 596 patients underwent complete VATS lobectomy. The average number of stapler cartridges used for VATS lobectomy was 5.3±1.9. The number of stapler cartridges used for VATS lobectomy was higher in men (5.5±1.9 vs. 5.0±18, p=0.006), those aged older than 70 years (5.5±2.1 vs. 5.1±1.7, p=0.038), those who underwent upper or middle lobectomy procedures (5.7±1.9 vs. 4.1±1.2, p<0.001), those with a higher fissure sum average (p<0.001), and those in whom surgery was performed by a surgeon with a preference for staplers (5.6±2.0 vs. 4.9±1.6, p<0.001). Conclusion: The number of stapler cartridges required to perform VATS lobectomy in NSCLC patients appears to be influenced by sex, age, the location of the tumor, the degree of fissure development, and the surgeon's preference.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.724-730
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• 1989

The development of severe pericardial adhesion after cardiovascular surgical procedures often increases the risk of injuring the heart, great vessels, or extracardiac grafts during resternotomy. Several pericardial substitutes have been tested in an attempt to facilitate reoperation with inconclusive results. This study was designed to evaluate the applicability of two different materials as pericardial substitutes to minimize the pericardial adhesion and epicardial reaction. A procedure for induction of pericardial adhesion was carried out in 30 rabbits. Rabbits were divided into three groups of ten rabbits each: Group 1[control, simple pericardial closure]: Group 2[bovine pericardium as pericardial substitute]: Group 3[e-polytetrafluoroethylene surgical membrane, e-PTFE as a pericardial substitute]. Bovine pericardium or e-PTFE surgical membrane was interposed between the sternum and the heart. Rabbits were sacrificed at 4 weeks after operation. The development of adhesions and epicardial reactions were graded as: none [I]; minimal[II]; moderate[Ill]; and severe[1V]. Histologic studies of the substitute, the pericardium, and the epicardium were performed. The results were as follows; l. In group 1[control group], the degree of pericardial adhesions were grade I in none, grade II in 1, grade III in 3, and grade 1V in 6 animals. Epicardial reactions were grade I in none, grade II in 3, grade K in 4, grade 1V in 3 animals respectively. 2. In group 2[bovine pericardium], the degree of pericardial adhesions were grade I in 1, grade II in 5, grade III in 3, and grade 1V in 1 animal. Epicardial reactions were grade I in 1, grade II in 2, grade III in 4, and grade 1V in 3 animals respectively. 3. In group 3[e-PTFE], the degree of pericardial adhesions were grade I in 7 animals, grade II in 2, grade III in 1, and grade g in none. Epicardial reactions were grade I in 4, grade II in 3, grade III in 2, and grade IV in 1 animal respectively. Pericardial adhesions more than grade II were 90.9% in group 1, 40 % in group 2, and 10% in group 3. Pericardial adhesions were significantly reduced in group 3 compared to group 1 or 2. Epicardial reactions more than grade II were 70 % in group 1, 70 % in group 2 and 30 % in group 3. We concluded that this 0.1mm thick polytetrafluoroethylene surgical membrane is a suitable pericardial substitute to minimize the development of pericardial adhesion or epicardial reaction following cardiovascular surgery.

• Journal of Yeungnam Medical Science
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• v.41 no.3
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• pp.213-219
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• 2024

Background: Aortic valve replacement (AVR) has recently been performed at many centers using a minimally invasive approach to reduce postoperative mortality, morbidity, and pain. Most previous reports on minimally invasive AVR (MiAVR) have mainly focused on aortic stenosis, and those exclusively dealing with aortic regurgitation (AR) are few. The purpose of this study was to investigate early surgical results and review our experience with patients with chronic severe AR who underwent AVR via right anterior mini-thoracotomy (RAT). Methods: Data were retrospectively collected in this single-center study. Eight patients who underwent RAT AVR between January 2020 and January 2024 were enrolled. Short-term outcomes, including the length of hospital stay, in-hospital mortality, postoperative complications, and echocardiographic data, were analyzed. Results: No in-hospital mortalities were observed. Postoperative atrial fibrillation occurred temporarily in three patients (37.5%). However, none required permanent pacemaker implantation or renal replacement therapy. The median values of ventilator time, length of intensive care unit stay, and hospital stay were 17 hours, 34.5 hours, and 9 days, respectively. Preoperative and postoperative measurements of left ventricular ejection fraction were similar. However, the left ventricular end systolic and diastolic diameters significantly decreased postoperatively from 42 mm to 35.5 mm (p=0.018) and 63 mm to 51 mm (p=0.012), respectively. Conclusion: MiAVR via RAT is a safe and reproducible procedure with acceptable morbidity and complication rates in patients with chronic severe AR. Despite some limitations such as a narrow surgical field and demanding learning curve, MiAVR is a competent method for AR.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.76-80
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• 2018

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.63-66
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• 2015

We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.335-342
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• 2008

Background: Congenital cystic diseases of the lung are uncommon, and they share similar embryogenic and clinical characteristics. But they are sometimes vary widely in their presentation and severity. Therefore they are often difficult to make different diagnosis each other, and all require surgical treatment. Material and Method: From 1993 to 2006, 38 patients underwent surgical procedures under these diagnostic categories in the Depart. of Thoracic and. Cardiovascular Surgery, Busan-Paik Hospital, College of Medicine, Inje University. And we retrospectively reviewed these patients' charts for clinical presentations, surgical procedures, pathologic findings and postoperative morbidity and mortality. Result: There were 22 males and 16 females, ages ranged from 1 month after birth to 51 years and mean age was 20.8 years. The main symptoms were 19 fever, cough, sputum production due to recurrent infection, 7 dyspnea, 8 chest discomfort, 4 hemoptysis, but eight patients were asymptomatic. Computed tomography was chosen as diagnostic modalities and available for operation plan for all of patients. For all the cases, surgical resection were performed. Lobectomy was performed in 28 patients, simple excision (resection) in 8 patients, segmentectomy or wedge resection in 2 patients. There were 10 pulmonary sequestrations, 15 congenital cystic adenomatoid malformations (CCAM), 11 bronchogenic cysts, and 2 congenital lobar emphysemas. They all were confirmed by pathologic exams. The complications were 6 wound disruption or infection, 2 chylothorax, 1 ulnar neuropathy, but all of them were resolved uneventful. There was no persistent air leakage, respiratory failure, operative mortality and recurrence. Conclusion: We performed immediate surgical removal of congenital cystic lung lesions after diagnosis and obtained good results, so reported them with literature review.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.282-286
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• 2018

True extracranial carotid artery aneurysms (ECCAs) are uncommon. Atherosclerosis is the most common etiological factor. Neck pain, a pulsatile mass and murmur at auscultation are the most common symptoms. ECCAs may exhibit severe clinical manifestations due to complications. Cases of rupture can be fatal. There is a risk of distal embolization and stroke in thrombosed cases. We discuss two cases of enlarged ECCA treated surgically in the light of the most recent literature.

• Journal of Chest Surgery
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• v.52 no.5
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• pp.372-375
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• 2019

A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.