• Journal of Chest Surgery
• /
• 제33권9호
• /
• pp.729-733
• /
• 2000

Background: Recent trends suggest that minimally invasive cardiac surgery reduces postoperative morbidity and offers a cosmetic benefit. This study was performed to evaluate the CPB time, ACC time, OP time, ICU stay and postoperative hospital stay following a lower partial sternotomy and those of the median sternotomy. Material and Method: A group of 26 adult patients who underwent cardiac surgery through lower partial sternotomy from August 1997 to July 1999(A group) were compared to 45 adult patients who underwent cardiac surgery through median sternotomy from January 1996 to July 1997(B group). The mean ages(46.4$\pm$14.6 years, A group and 46.8$\pm$13.2 years, B group) were similar. Operations were performed with central cannula and antegrade/retrograde blood cardioplegia. Result: There was no death in each group. No differences were found in CPB time, ACC time, OP time, ICU stay and postoperative hospital stay. Postoperative complications were sternal splitting in a patient in group A and a patient with bleeding that required reoperation and a patient with delayed wound closure in group B. Conclusion: The lower partial sternotomy offered a cosmetic benefit, but does not significantly reduced the length of operative time and hospital stay. Minimally invasive cardiac surgery will be applied increasing because of the suggested advantage and choosing a proper operative technique will be helpful.

• Journal of Chest Surgery
• /
• 제33권2호
• /
• pp.183-185
• /
• 2000

With the marked decrease in operative mortality in simple heart diseases there have been several reports on the minimally invasive and cosmetic techniques including submammary incision right parasternal approach right anterolateral thoracotomy partial sternotomy and subxiphoid approach. We report here subxiphoid approach without sternotomy for the repair of atrial septal defect as the procedure that has less invasive technique and more cosmetic effect.

• 대한기관식도과학회지
• /
• 제4권1호
• /
• pp.101-104
• /
• 1998

Partial splitting of the upper sternum provides an excellent surgical view in reconstruction of the intrathoracic trachea. However, when deep-seated mediastinitis develops postoperatively, it is difficult to manage especially when combined with sternal osteomyelitis. It also needs an additional consideration compared to the usual treatment modality applied to mediastinitis following a standard median stemotomy because the lower part of the stemum remains intact. We treated a 50 year old female patient with deep-seated mediastinitis and sternal osteomyelitis following resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. The patient underwent extensive stemectomy, omental free grafting, and pectoral myocutaneous flap. Postoperative viability of the free-grafted omentum was evaluated by angiography and CT scan.

• Journal of Chest Surgery
• /
• 제28권12호
• /
• pp.1155-1159
• /
• 1995

Differentiated thyroid carcinoma is a slow growing tumor with relative good prognosis. But locally advanced thyroid cancer with T4 or N1b is difficult to manage. Between June 1988 and April 1995, we resected 8 advanced thyroid cancers trans-sternally. All patients had direct mediastinal extension [T4 or mediastinal lymph node metastasis [N1b with airway obstruction or dysphagia. We operated all the patients by partial or total sternotomy for mediastinal dissection along with thyroidectomy and radical neck dissection. There were some acceptable morbidities but no operative mortality. Postoperative radioactive iodine therapy was followed without side effects. Follow-up survival period was between 11 months to 81 months with 2 late mortalities [17 month, 30 month . Although definite benefit for routine mediastinal dissection in thyroid cancer has not been established, in locally advanced cases impending airway obstruction or dysphagia who have questionable effect by radioactive iodine therapy alone, aggressive mediastinal mass dissection including lymph node metastasis has the significant role to prevent the patients from suffocation & dysphagia, and to enhance the effect of followed radioactive iodine tharapy.

• Journal of Chest Surgery
• /
• 제23권3호
• /
• pp.522-526
• /
• 1990

We have experienced 2 cases vocal cord paralysis after open heart surgery. One was a postoperatively developed right unilateral vocal cord paralysis after prosthetic mitral valve replacement with tricuspid valve annuloplasty. The other was a postoperative left unilateral vocal cord paralysis after prosthetic aortic and mitral valve replacement with tricuspid annuloplasty. They were intubated for forty-eight and seventy-two hours but after extubation complained of hoarseness, aphonia, anxiety, and ineffective coughing Indirect laryngoscopy performed at about postoperative one week, revealed partial paralysis and decreased mobility of the vocal cord. After active phonation therapy, symptoms were improved gradually and in the follow up indirect laryngoscopy, the vocal cord paralysis was improved. The symptoms were recovered completely at about postoperative one month in both. The cause of vocal cord paralysis after open heart surgery may be any retraction or stretching injury to the recurrent laryngeal nerve, especially right side, during median sternotomy retraction and open heart operation procedures. As a result, avoid of excessive spread of median sternotomy retractor and excessive manipulation and retraction of the heart during open heart procedures will reduce the occurrence of the vocal cord paralysis.

• Journal of Chest Surgery
• /
• 제32권4호
• /
• pp.368-372
• /
• 1999

배경: 선천성 심장 질환에서의 최소 피부 절개에 대한 보고는 매우 적다. 저자등은 수술상처를 최소화하면서 통상적인 수술수기 및 시야를 확보할 수 있는 방법을 고려하였다. 대상 및 방법: 저자등은 1997년 4월부터 1997년 9월까지 선천성 심장 질환 환자 40명을 대상으로 최소 피부 절개술과 정중 전 흉골 절단을 통해서 개심술을 시행하였다. 환자 질병 분포는 성인 환자가 5명(남:여=1:4)이며 이중, 심방 중격 결손증 3명, 심실 중격 결손증 1명, 부분 심내막상 결손증 1명이었고, 소아 35명(남:여=17:18)에서는 심방 중격 결손증 4명, 심실 중격 결손증 30명, 발살바 동맥류 1명이었다. 정중 피부 절개는 흉골 두번째 늑간하부에서 검상돌기 1~2cm상방까지 실시하였다. 흉골 하부 절단에는 일반 전기톱을, 흉골 상부 절단에는 특수 전기톱을 피부 밑에 삽입하여 전장의 흉골을 절단하였다. 그리고, 흉골 견인은 좌우 & 상하 양방향에 2개의 견인기를 각각 직각으로 거치하여 수술시야를 확보하였다. 결과: 흉골길이대비 피부절개의 길이는, 성인에서는 55.0$\pm$3.5%로 절개길이가 평균 12cm(10~13.5cm)였고, 소아에서는 63.1$\pm$3.9%로 평균 7.3cm(5.2~11cm)였다. 모든 증례에서 체외 순환시 필요한 동정맥 삽관을 추가적인 서혜부 피부 절개 없이 직접 대동맥 및 상하공 대정맥에 시행할 수 있었으며 좌심방벤트관은 필요시 삽입하였다. 전 례에서 수술사망이나 합병증은 발생하지 않았으며, 최소 피부 절개술에 따른 창상 감염 및 피부 괴사, 혈종 형성, 출혈에 의한 합병증은 없었다. 결론: 이상의 결과로 최소 피부 절개술과 정중 전 흉골 절개를 이용한 선천성 심장 질환 수술은, 통상적인 체외 심폐 순환을 할 수 있으며, 외관상 미용의 효과가 뚜렷하였고, 다양한 선천성 심질환에서 안전하고 효과적으로 사용될 수 있다고 판단된다.

• Journal of Chest Surgery
• /
• 제32권11호
• /
• pp.1009-1016
• /
• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Journal of Chest Surgery
• /
• 제32권2호
• /
• pp.181-184
• /
• 1999

심근교에 의한 관상동맥협착은 드문 질환으로 흉통, 심근경색 및 심실세동을 유발할 수 있다. 약물치료에 반응이 없는 심근교는 심근절개술의 적응이 된다. 저자들은 흉골부분절개술하 심폐바이패스없이 좌전하행지부위에 심근절개술을 성공적으로 시행하였기에 보고하는 바이다

• Journal of Chest Surgery
• /
• 제33권1호
• /
• pp.96-98
• /
• 2000

A cosmetic incision for minimal invasive cardiac surgery is described. Through a small submammary skin incision combined with partial low sternotomy some kinds of cardiac operations are possible without extra-difficulty but with excellent cosmetic effect, No special instruments nor techniques are required. By this method routine cannulations for cardiopulmonary bypass as well as aortic cross clamping bicaval snaring and venting of cardiac chambers are possible, We performed 5 cases of open heart surgeries using this approach which includes two cases of atrial septal defect closure one case of ventricular septal defect closure one case of pulmonic valvotomy and one case of mitral valve replacement.

• Journal of Chest Surgery
• /
• 제31권5호
• /
• pp.466-471
• /
• 1998

연구목적: 소아연령군에서의 최소침투적심장수술의 적용가능성 여부와 안전성 및 효율성 등을 검증해 보기 위해 본연구를 시행하였다. 대상환아) 1997년 7월부터 1997년 11월까지 본 서울대학교병원 어린이병원 흉부외과에서 최소침투적심장수술을 받은 46례의 환아를 대상으로 하였으며 환아의 평균 연령 및 체중은 각각 34.6$\pm$41.8 (범위:1~148) 개월, 14.5$\pm$9.9 (범위:3.0~40.0) kg였다. 28명의 환아가 남아였으며 술전 진단은 15례의 심방중격결손증, 25례의 심실중격결손증 (이중 16례는 막주변형이었고 1례는 대동맥판하 막성협착을 동반함), 1례의 대동맥내 이물, 3례의 부분방실중격결손증, 1례의 전폐정맥연결이상 (심장형), 1례의 활로씨사징증이었다. 수술방법 : 상흉골함요(陷凹)로부터 가능한 하부로 멀리 떨어져 정중피부절개를 가한후, 하부흉골을 노출시켰다. 검상돌기부터 정중흉골절개를 시작하여 제 2늑간 수준까지 연장한 후, 흉골의 한쪽 또는 양쪽에 횡절개를 가하여 T형, J형, I형 또는 역 C형 흉골절개가 되게하여 우측 또는 양측 들창모양의 흉골개구부를 확보하였다. 삽관을 대동맥과 상,하공정맥에 일반적인 방법으로 시행하고, 질환별 수술방법 역시 통상적인 방법에 의해서 시행되었다. 결과 : 평균 피부절개의 길이는 6.1$\pm$1.0 (범위:4.0~9.0) cm였고 상흉골함요와 피부절개상단사이의 거리는 평균 4.0$\pm$1.1 (범위:2.0-7.0) cm였다. 평균심폐우회시간, 대동맥차단시간, 및 총수술시간은 각각 62.9$\pm$20.0 (범위:28~147), 29.8$\pm$12.8(범위:11~79), 161.1$\pm$34.5(범위:100~250) 분이었다. 수술후 수혈총량은 평균 71.0$\pm$68.1 (범위: 0~267) cc였으며 환아는 평균 11.3$\pm$13.8 (범위:1-73) 시간후에 인공호흡기이탈이 가능하였다. 진통제로는 평균 0.8$\pm$1.8 (범위: 0~9) mg 용량의 모르핀이 사용되었으며 환아는 평균 35.0$\pm$32.2 (범위: 10~194) 시간동안 중환자실 관리가 필요했고 평균 재원기간은 6.2$\pm$2.0 (범위: 3~11) 일이었다. 상흔관련 합병증 및 수술사망례는 발생하지 않았다. 결론: 비록 단기간의 관찰이었지만 본연구를 통해 저자등은 소아연령군에서 일부 선천성 심질환에 대하여 최소침투적심장수술의 적용의 가능성 및 유용성을 입증하였으며 특히 미용효과면에서 탁월하다는 사실을 발견하였다.