• Title/Summary/Keyword: Sternotomy

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Thoracoscopy for Diagnosis and Treatment of Pneumothorax Under Local Anesthesia; Analysis of 68 patients (국소마취하의 흉강경의 임상적 응용)

  • 홍순필
    • Journal of Chest Surgery
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    • v.26 no.3
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    • pp.204-208
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    • 1993
  • The review of 68 patients, who were diagnosed as spontaneous pneumothorax during the period from Dec, 1991. to Jul, 1992. were performed thoracoscopy of 70 cases under local anesthesia with 1% lidocaine at the department of thoracic & cardiovascular surgery, HanYang University Hospital. Clinical data on distribution of Age & Sex, Location, Frequency of Reccurrence and other aspects of pneumothorax were summerized.37 cases were treated by thoracoscopic management and closed thoracostomy. As thoracoscopic management, Electrocauterization of bullae or blebs[37 cases], Endo-clip application [2 cases], Removal of foreign body[1 case] were performed. 31 cases were cured by open thoracotomy. The thoracotomy indications under thoracoscopic finding were followed as: 1. Severe pulmonary adhesion and destroyed lung parenchyme 2. multiple bullae or blebs on several areas 3. finding of pulmonary tuberculous caseous lesion 4. persistant air leakage after 7 days from thoracoscopic management Excision, wedge resection of bullae or blebs was performed in most cases [22 cases], 2 cases by median sternotomy and Segmentectomy of 7 cases were carried out depending on the pathologic change of lung.There was no operative mortality and Follow-up for all patients were showed good results.

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Surgical Treatment of Chronic Constrictive Pericarditis (만성 교약성 심낭염의 외과적 치료)

  • Jang, Bong-Hyeon;Kim, Gyu-Tae
    • Journal of Chest Surgery
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    • v.20 no.2
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    • pp.317-322
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    • 1987
  • Records of 15 patients who underwent operation for constrictive pericarditis at this department from 1976 through 1984 were reviewed. All had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. There were 12 males and 3 females in this series. Range of age varied from 7 years to 51 years. Clinical and histological study revealed granulomatous pericarditis compatible with the diagnosis of tuberculosis in 5 patients, non-specific chronic inflammatory changes in 6 patients and pyogenic pericarditis in 2 patients. Pericardiectomy was performed through a median sternotomy [11 cases] or bilateral anterior thoracotomy [4 cases]. The postoperative complications were observed in 4 patients. Low cardiac output was the most common complication [2 patients]. In 13 cases, excluding 2 operative deaths, preoperatively all were in New York Heart Association Class III or IV. At the time of discharge II [85%] were in Class I or II. 4 Cases were reoperated after original pericardiostomy and all resulted in marked improvement. Early surgical intervention is advisable in all patients in whom cardiac constriction is caused by either a thickened pericardium or a pericardial effusion before myocardial dysfunction occurs.

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One Stage Eepair of Interruption of Aortic Arch with VSD in Neonate (신생아에서 심실중격결손증을 동반한 대동맥궁 결손증의 일단계 완전 교정술 -3례 치험-)

  • 전희재
    • Journal of Chest Surgery
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    • v.28 no.6
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    • pp.610-618
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    • 1995
  • Three neonates with interrupted aortic arch with VSD underwent one stage repair using revised technique of cardiopulmonary bypass with short period of circulatory arrest. A left posterolateral thoracotomy was made to permit mobilization of the descending aorta and placement of polytetrafluoroethylene[PTFE graft for distal aortic perfusion. Then the patient was placed in the supine position and a median sternotomy was performed to permit the proximal dissection, VSD repair, and direct anastomosis between the ascending aorta and descending aorta. This technique has advantages to facilitate direct anastomosis between the ascending aorta and the descending aorta, to lessen circulatory arrest time, and to prevent dangerous laceration and post-operative narrowing of the thin small ascending aorta at cannulation site. There was no operative mortality but postoperative stenosis developed in one case which was relieved with balloon aortoplasty.

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Airway Improvement with Medium-Term Compression Duration after Right Pulmonary Artery Anterior Translocation

  • Jang, Woo Sung;Kim, Jae Bum;Kim, Jae Hyun;Choi, Hee Jeong
    • Journal of Chest Surgery
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    • v.51 no.1
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    • pp.57-60
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    • 2018
  • Left main bronchus compression occasionally occurs in patients with cardiac disease. A 19-month-old female patient weighing 6.7 kg was admitted for recurrent pneumonia and desaturation. S he had an atrial septal defect (AS D) with a right aortic arch. Her left main bronchus had been compressed between the enlarged right pulmonary artery (RPA) and the descending thoracic aorta for 14 months. We conducted ASD closure and RPA anterior translocation via sternotomy. The left main bronchus compression was relieved despite the medium-term duration of compression.

Minimally Invasive Mitral Valve Repair in a Woman with Marfan Syndrome and Type B Dissection

  • Lim, Mi Hee;Je, Hyung Gon;Lee, Sang Kwon
    • Journal of Chest Surgery
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    • v.51 no.1
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    • pp.61-63
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    • 2018
  • We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.

Minimally Invasive Redo Mitral Valve Replacement under Fibrillatory Arrest in a Patient with a Calcified Aorta and Patent Previous Bypass Grafts

  • Kim, Seung Hyun;Kim, Hak Ju;Hwang, Ho Young
    • Journal of Chest Surgery
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    • v.51 no.4
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    • pp.283-285
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    • 2018
  • A 73-year-old woman who underwent combined bioprosthetic mitral valve replacement, tricuspid ring annuloplasty, and coronary artery bypass grafting 12 years previously visited our clinic due to aggravated dyspnea caused by structural valve deterioration of the mitral prosthesis. Because aortic or femoral artery cannulation and cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta and ilio-femoral vessels, and because there was a risk of redo sternotomy due to the patent bypass grafts, a comprehensive approach including axillary artery cannulation, a minimally invasive right thoracotomy approach, and a clampless hypothermic fibrillatory arrest technique was used during redo mitral valve replacement.

Supra-Arterial Myotomy without Cardiopulmonary Bypass for Myocardial Bridging -One case report- (심폐바이패스없이 관상동맥 심근교의 수술치험 -1례 보고-)

  • 김재현;최세영;유영선;이광숙;윤경찬;박창권
    • Journal of Chest Surgery
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    • v.32 no.2
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    • pp.181-184
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    • 1999
  • Systolic coronary arterial narrowing, secondary to myocardial bridging which is capable of producing chest pain, myocardial infarction and ventricular fibrillation is a known but an uncommon entity. A supra-arterial myotomy in a case of myocardial bridge causing medication-refractory angina is described. Under the partial sternotomy incision, we performed a supra-arterial myotomy in the left anterior descending coronary artery without cardiopulmonary bypass. The postoperative course was uneventful.

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Minimal Invasive cardiac Surgery ; Small Submammary Incision (유방하 횡절개를 이용한 최소침습 심장수술)

  • 정승혁;신용철;임용택;김병일;이정호
    • Journal of Chest Surgery
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    • v.33 no.1
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    • pp.96-98
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    • 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.

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One-Stage Repair of Interrupted Aortic Arch and Aortopulmonary Window in a Neonate (신생아에서 대동맥궁단절과 대동맥폐동맥창의 일차 완전교정)

  • 성시찬;김시호;우종수;이영석
    • 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.

Aortoesophageal Fistula after Prosthetic Patch Aortoplasty for Mycotic Aneurysm of the Descending Thoracic Aorta (진균성 하행 흉부 대동맥류에서 인조 절편 대동맥 성형술 후 발생한 대동맥-식도 누공 -치험 1례 보고-)

  • 이홍섭
    • Journal of Chest Surgery
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    • v.33 no.10
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    • pp.839-842
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    • 2000
  • Aortoesophageal fistula is an uncommon and fatal complication after surgery of aortic aneurysm. A case of aortoesophageal fistula as a complication of synthetis patch aortoplasty for mycotic aneurysm of descending thoracic aorta is described. After 3 months since patch aortoplasty for mycotic aneurysm of descending thoracic aorta this patient visited the emergency room due to melena and hematemesis. After gastrofiberoscopy and computed tomography the patient was taken ot the operating room. The surgical intervention was performed in two steps. Median sternotomy and midline laparotomy were made. Hemashield's Dacron(16mm) bypass between ascending thoracic aorta and infra-renal abdominal aorta was established first. Through the posterolateral thoracotomy false aneurysm and previous Hemashield's Dacron patch of descending aorta were resected. The two ends of the aorta were sutured and esophageal fistula was repaired. The esophageal suture line and the stumps were covered with omental graft. Thirty months later the patient has had no difficulty referable to the aortic surgery.

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