• Journal of Chest Surgery
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• v.46 no.5
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• pp.340-345
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• 2013

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of $16.5{\pm}9.7$. Group II comprised 14 female and 3 male patients with an average age of $18.5{\pm}9.8$ showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was $1.8{\pm}0.2$. The average pulmonary artery pressure was $35{\pm}10$ mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

• Journal of Digital Convergence
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• v.17 no.7
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• pp.265-274
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• 2019

The purpose of this study was to know the difference in pain, sleep, self-care behavior in patients performed by sternotomy and robotic minimally invasive cardiac surgeries. The participants were 64 patients with sternotomy and 64 patients with minimal thoracotomy in heart valve surgeries at a tertiary hospital in Seoul. Data were analyzed using descriptive statistics, ${\chi}^2$ test, paired t-test. with SPSS/WIN(22.0). The participants with minimally invasive thoracotomy felt severe pain than the patients with thoracotomy at post operation day 2 & 5. The severe pain site were the surgical site in both groups. The participants with sternotomy had better sleep than minimally invasive thoracotomy patients. Self-care behavior was higher in the minimally invasive thoracotomy group. Therefore, despite the many advantages of robotic surgery such as rapid recovery and shortening of length of stay in hospital, accurate pain assessment and application of differentiated protocols are needed for the management of pain in the patients with robotic minimally invasive cardiac surgeries. In addition, a structured education program intervention is needed to improve comfort by considering gender, age, and method of operation.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.714-716
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• 2005

In an extremely enlarged right heart, the repeated midline sternotomy was considered to involve the risk of massive hemorrhage. A right thoracotomy provides a convenient and safe way to approach the tricuspid valve in patient who have had previous heart surgery through a midline sternotomy.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.421-427
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• 2005

Although the incidence of mediastinal wound infection in patient undergoing median sternotomy for cardiovascular surgery is relatively low(less than 1%), it is not only a devastating and potentially life-threatening complication but also associated morbidity, mortality and cost are unacceptably high. During the past few decades various methods had been applied for the treatment of postoperative mediastinitis. Currently, chest wall reconstruction by using muscle flaps-especially pectoralis major muscle and rectus abdominis muscle are commonly selected for the reconstruction after wide debridement has become widely accepted. We performed bilateral pectoralis major-rectus abdominis muscles in-continuity bipedicle flap to overcome the limit of each flap for reconstruction of sternal defects in 17 patients. We analyzed the results of the surgery. Recurrent infection developed in 17.6% of cases and abdominal herniation was observed in one patient. There was no postoperative hematoma or death. We conclude that this flap is very valuable in reconstruction of the anterior chest wall defect caused by post-sternotomy infection because it provides sufficient volume to fill the entire mediastinum, and the complication rate compares favorably to that of other methods.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.683-687
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• 1987

Bleeding from bone marrow after sternotomy for open cardiac surgery can be sometimes difficult to control and even lead to reoperation for hemostasis. A clinical comparative study was carried out to demonstrate the hemostatic effect of fibrin glue [Beriplast] for sternal marrow bleeding after sternotomy for open heart surgery. Postoperative blood loss was measured in two patient groups, group A included 19 patients operated upon from June to October 1987 and the fibrin glue was applied to the sternal marrow together with collagen fleece and group B consisted of 22 patients from January to May 1987 and only collagen fleece was applied without fibrin glue. There was no difference between two groups in age and sex distributions, coagulation state, method of extracorporeal circulation and operative management. The blood loss one hour after operation was 2.04 ml/hr/kg in group A and 3.55 ml/hr/kg in group B [P<0.001]. The most significant difference was observed during the first 4 hours after surgery with 1.34 ml/hr/kg versus 2.05 ml/hr/kg. over the following 20 hours the amount of drainage from the chest tubes was identical in both groups. Fibrin glue reduces blood loss after open heart surgery by local hemostasis at sternum. Our study has shown that local application of fibrin glue to sternal marrow is an effective method of controlling the sternal bleedings. No side effect or complication of fibrin glue was noted.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.308-311
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• 2010

Coarctation of the aorta is frequently associated with intracardiac disease. It is very difficult to decide on the best method for surgically treating adult patients with these combined heart diseases. We performed single-stage repair via a modified Bentall operation and by creating an intrapericardial ascending-descending aortic bypass through a median sternotomy in a patient with coarctation of the aorta and annuloaortic ectasia, and the latter was associated with aortic valve regurgitation.

• Journal of Chest Surgery
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• v.26 no.1
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• pp.54-58
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• 1993

Simultaneous bilateral bleb resection was done through bilateral transaxillary thoracotomy in 10 patients with spontaneous pneumothorax during the period from May 1991 to Novemver 1992 in whom bilateral bulla or bleb was detected with using simple chest X-ray and chest CT scanning. To compare the effectiveness of bilateral transaxillary thoracotomy, we investigated 10 unilateral transaxillary thoracotomy patients with spontaneous pneumothorax and two clinical reports from other institutes which dealt the results of bilateral bleb or bulla resection through median sternotomy also. In bilateral transaxillary thoracotomy group,mean operation time was 115 minute,mean intraoperative bleeding was 329 cc, mean postoperative hospital stay was 7.5 days. Postoperative ABGA[Arterial Blood Gas Analysis] was in normal range and postoperative recovery rates of FVC[Forced Vital Capacity], FEV1[Forced Expiratory Volume at 1 second], TV[Tidal Volume] were 84.3%, 93.4%, 88.7%,respectively. In median sternotomy group,mean operation time was 129 minute,mean intraoperative bleeding was 490 cc, mean postoperative hospital stay was 12.4 days. Postoperative ABGA was in normal range and postoperative recovery rates of FVC, FEV1 were 97.3%, 97.4%, respectively. In unilateral transaxillary thoracotomy group, postoperative ABGA was in normal range also and postoperative recovery rates of FVC, FEV1, TV were 91.6%, 99.0%, 96.0%,respectively. In conclusion, simultaneous bilateral bleb resection through bilateral transaxillary thoracotomy should be considered in pneumothorax patients with bilateral bleb or bulla because of cost-effectiveness[reducing hospital days] and better cosmetic result without any impairment in recovery of respiratory function.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.571-583
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• 1983

Thymic tumor is the most common neoplasm originating in the anterior mediastinum. Histologically, thymic tumors and tumorlike conditions have been classified into thymic cyst, thymolipoma, true thymic hyperplasia, thymoma and carcinoid tumor of the thymus gland. We have experienced several tumors and a few tumorlike conditions of the thymus gland in 10 patients: thymoma 6, thymic hyperplasia 2, carcinoid tumor 1 and thymic cyst 1. The age distributions were ranging from 30 to 60 years except for one 3 year old child [malignant thymoma, lymphocytic type], and male to female ratio was 1:1.5. In 6 cases, thymic lesions were removed through lateral thoracic incision [right 2, left 4] because the mediastinal masses were growing far into the pleural space, meanwhile, medially located lesions [4 cases] through median sternotomy incision. Among these 10 patients, 3 were malignant thymomas, in which 2 were died of recurrence after tumor resection. Myasthenia gravis was all noted in 3 females [thymoma 2, thymic follicular hyperplasia 1], in which only two revealed remission in symptoms following thymectomy. The authors would like to recommend early radical thymectomy through median sternotomy incision whenever patients demonstrate suspicious thymic tumor lesions on the chest roentgenogram or generalized myasthenic symptoms.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1377-1380
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• 1996

Severe hemodynamic dysfunction may follow after the closure of the median sternotomy in patients with myocardial edema, cardiac dilatation, and severe postoperative bleeding. In extreme cases, myocardial edema may be so severe that cardiac function is compromised merely by the edges of the open sternum touching the heart. Sternotomy remained open and delayed sternal closure is already described adjunct in complicated cardiac operations. We experi nced a case of delayed sternal closure after 16 hours of CABG using synthes DCP wide plate in a 54-year old obese female patient. Our experience conims that delayed sternal closure Is an effective at simple means of dealing with severe myocardial edema so we report this case with literature review.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.101-104
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• 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.