• Journal of Chest Surgery
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• v.56 no.3
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• pp.224-227
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• 2023

Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with end-stage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.825-830
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• 2007

Background: Minimally invasive cardiac surgery appears to offer certain advantages such as earlier postoperative recovery and a greater cosmetic effect than that achieved through conventional sternotomy. However, this approach has not yet been widely adopted in Korea to replace complex open heart surgery such as mitral valve reconstruction. This study compared the results of robot assisted minimally invasive mitral valve repair with those results of conventional sternotomy. Material and Method: From December 1993 to December 2005, 520 consecutive patients underwent mitral valve reconstruction for mitral regurgitation in our institution. These patients were subdivided according to those whose surgery used the conventional sternotomy approach (Group S, n=432) and those who underwent minimally invasive right anterior thoracotomy (Group M, n=88); we then compared the clinical results of both groups. When we performed minimally invasive right thoracotomy, we used a robot (AESOP 3000) and made an incision less than 5 cm. Result: Our study patients in both groups were similar for their age, gender and preoperative ejection fraction. There were two hospital mortalities in group S. but there was no mortality in the group M patients. Significant reductions in the ICU stay and the postoperative hospital stay were observed in the group M patients compared with the group S patients. However, both the bypass time and the aortic cross-clamp time were significantly longer in the group M patients. In spite of the confined incision in the group M patients, there were no limitations on the mitral valve repair techniques. There was a similar frequency of postoperative significant residual mitral regurgitation in both groups. Conclusion: In this study, the minimally invasive mitral valve repair showed comparable early results with the conventional sternotomy patients. We will now need long-term follow-up of these patients who underwent minimally invasive mitral valve repair, but we anticipate that based on the results of this study, we will begin to routinely perform minimally invasive cardiac surgery as out primary approach for mitral valve reconstruction.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.438-441
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• 1999

Background: Minimally invasive cardiac surgery has emerged as a new approach to the conventional median sternotomy. The suggested advantages of the minimally invasive technique includes improved cosmesis, simplicity of opening and closing the chest, less postoperative pain, less risk of infection and bleeding, early rehabilitation, and reduced length of hospital stay. Material and Method: Between March 1997 and December 1997, we performed 36 cases of minimally invasive cardiac surgery via three different approaches ; right paramedian, transverse sternotomy and mini-sternotomy with upper sternal split. Result: There was no operative mortality. Postoperative complications were atrial fibrillation in 4 patients, bleeding that required reoperation in 1 patient, and delayed wound closure in 1 patient who underwent 3rd redo operation. Average length of skin incision was 9.1${\pm}$0.9 cm. Average duration of stay in the intensive care unit was 48${\pm}$29 hours and the patients were discharged 10${\pm}$7 days after the operation. Conclusion: In spite of the difficulties in defibrillation, deairing, and cardiac decompensation, minimally invasive approaches will be applied increasingly because of the suggested advantages.

• Journal of Chest Surgery
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• v.27 no.9
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• pp.801-803
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• 1994

We report a case of a 45-year-old woman with Budd-Chiari syndrome caused by the obstruction of the inferior vena cava just below the diaphragm. Transatrial dilatation or membranotomy was not possible due to the severe fibrotic obliteration of the inferior vena cava. Instead, cavoatrial bypass with a Dacron graft[20 mm-Vascutek] was performed under the median sternotomy and median abdominal incision.The postoperative course was uneventful and generalized symptoms were much improved. During the following period[6 month] the graft patency was maintained with no recurrence of symptoms.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1112-1115
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• 1992

Lymphangioma, or cystic hygroma, a malformation resulting from the sequestration of lymph vessels, is owing to a failure of the primitive jugular lymphatic sacs to join with the venous system. They are rare benign lesions found more frequently in children than in adults. We experienced a case of huge mediastinal lymphangioma in 37-year-old female patient. It was associated with a cervical prolongation, and caused deviation and compression of the trachea and the heart. The cervicomediastinal lymphangioma was completely resected by means of median sternotomy, and the post-operative course was unevenful.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1116-1120
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• 1992

Posterior mediastinal goiter extending to carotid sheath posteriorly is rare repoted case. Recently we experienced huge posterior mediastinal goiter with compressin of trachea in 57-year old male, The patient that complained of dyspnea referred to our hospital for further evaluation of mediasitnal tumor. We confirmed huge secondary posterior mediastinal intrathoracic goiter with diagnostic methods following by chest X-ray, thyroid scan, chest CT, and CT guided fine needle aspiration biopsy in this patient, and performed operation for excision Exision of posterior mediasitnal goiter performed through initial transeverse cervical incision and additional median sternotomy, and the mass removed completely without any complications. The postoperative course were uneventful.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.427-431
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• 1987

A case is presented of a steering wheel Injury to the chest which developed right atrial free wall rupture and cardiac tamponade without rib fractures or hemo-pneumothorax. A 30 year old man who sustained, blunt chest trauma by steering wheel injury to his chest developed right atrial rupture and cardiac tamponade. Pericardiocentesis was performed and cardiac tamponade was confirmed. After a median sternotomy, large right atrial free wall laceration [about 8cm] was noted. He was placed on cardiopulmonary bypass. The laceration wound of right atrium was closed with a 2 rows of continuous suture. Recovery was uneventful. The patient has returned to his previous level of activity.

• Journal of Chest Surgery
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• v.24 no.8
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• pp.830-835
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• 1991

Tuberculosis is a chronic disease caused by Mycobacterium tuberculosis, which usually affects the lung but may cause lesions in any organ or tissue of the human body. Mediastinal lymph node involvement is common feature of intrathoracic tuberculosis in children. Sometimes the lymph node may be enlarged and it causes compressive symptoms. Recently we experienced two cases of tuberculous abscess at middle mediastinum. The abscess seemed to be originated from the mediastinal lymphadenitis, and caused the symptoms. Operation was performed by median sternotomy and by posterolateral thoracotomy incision respectively for the purpose of relieving symptoms and diagnosing the mediastinal mass. The symptoms were relieved completely and postoperative course was uneventful.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.160-162
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• 1993

Pulmonary lymphangiomyomatosis is rare but extremely interesting condition caused by progressive widespread smooth muscle proliferation in the perilymphatic regions throughout the lungs. The patient was a 25-year-old female. She had angiofibromas in the face, and angiomyolipoma in the left kidney which was removed 5 years earlier. Three years ago she started having severe dyspnea with bilateral pneumothoraces. Treatment was initiated with bilateral closed thoracotomies followed by open thoracotomy through median sternotomy and lung biopsy, which revealed the diagnosis of pulmonary lymphangiomyomatosis. Recurrence of pneumothorax was treated by repeated chemical pleurodesis with tetracycline. She has been in good condition during medroxyprogesterone administration for 3 years.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.209-212
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• 1995

Cystic hygroma is a cystic tumor developed by lymphatic stasis due to congenital blockage of regional lymphatic drainage. It ususally occurs at neck and axilla. However, in some cases of cervical cystic hygroma, cervical portions of the cysts may extend into the mediastinum. We experienced a case of huge cervico-mediastinal cystic tumor in 11 month old girl presenting a large fluctuating neck mass and severe respiratory distress. Surgical resection was done through combined approach of cervical incision and median sternotomy. Pathological diagnosis was confirmed to cervico-mediastinal cystic hygroma.