• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.4
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• pp.423-426
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• 2023

Backgrounds/Aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. This study aimed to establish current anticoagulation practices. Methods: A survey (https://form.jotform.com/220242489107048) was sent out to pancreatic surgeons. Questions covered center volume, venous resection/reconstruction techniques and anticoagulation policies. Results: Sixty-five centers from 17 countries responded. Following a "side-bite" venous resection with a patch repair, 40% used an autologous vein patch, 27% used peritoneum, and 27% used a bovine patch. After formally resecting a segment of vein, 17% of centers used an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (73%) grafts were the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a "side-bite" resection, 59%, 28%, and 19% of centers provided therapeutic anticoagulation, respectively (66% used low molecular-weight heparin). The duration of therapy provided varied from inpatient stay only (14%) to six months (32%). Conclusions: Our global survey indicates that anticoagulation practices are highly variable. Centers do not agree on when to anticoagulate, how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.440-445
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• 1985

Cor triatriatum is a variant of abnormal connection between the pulmonary vein and true left atrium, which is separated from accessory left atrium receiving pulmonary venous blood flow by fibromuscular diaphragm. Usually it is diagnosed after operation because difficulty in visualization of the diaphragm by conventional diagnostic tools. We experienced a rare entity of congenital heart disease diagnosed as car triatriatum with atrial septal defect and partial anomalous pulmonary venous return after completing operation, which was diagnosed as ASD with PAPVR preoperatively. Anomalous right pulmonary venous opening was located at right atrium, secundum type defect of atrial septum was present, and dual chambered left atrium without connection was also seen. Excision of the diaphragm and wide patch repair of ASD including right pulmonary vein were performed with good postoperative results. Herewith, we report this case with review of literatures.

• Journal of Chest Surgery
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• v.17 no.3
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• pp.488-491
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• 1984

Vascular injuries from gun shot wound is rare in these days, in Korea. A Case of false aneurysm of the right common carotid artery due to penetrating injury to the neck by carbine. The confirmatory diagnosis was made by right carotid angiogram which revealed bean-sized aneurysmal sac at the mid-portion of the right common carotid artery. Despite of no symptoms, emergency false aneurysmectomy and reconstruction with on-lay vein patch graft using left greater saphenous vein for threat of rupture and embolization from mural thrombi. During repair of common carotid artery, cerebral circulation was maintained with internal shunt. The postoperative course was uneventful except limit of motion of right upper extremity due to initial injury.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.177-179
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• 1995

Sinus venosus type atrial septal defect is commonly associated with partial anomalous pulmonary venous return[PAPVR . Ideal surgical repair of sinus venosus ASD with PAPVR demands complete closure of septal defect with redirection of the anomalous pulmonary venous return to the left atrium without obstructing the superior vena cava[SVC or the anomalous pulmonary vein and without injury of sinoatrial node and residual shunt. In our two patients, the closure of sinus venosus ASD and correction of PAPVR could be accomplished by simple direct sutures without using a patch or flap. Both patients had a good outcome.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.168-172
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• 1998

Inferior sinus venosus defect is a rare lesion in which there is a large interatrial communication adjacent to the atrial connection of the inferior caval vein. The defect is located posteriorly and inferiorly, outside the confines of the true atrial septum, and partial anomalous pulmonary venous connections are the rule. We underwent surgical repair in four patients with inferior sinus venosus defect and partial anomalous pulmonary venous return. There were three males and one female with an age range from four months to 25 years. A cross- sectional echocardiogram and cardiac catheterization had been performed preoperatively in all patients, but the correct diagnosis had been made in only one case. Surgical repair was indicated due to congestive heart failure, and one patient of 4-month-old needed urgent operation. The repair was accomplished by suturing a untreated autologous pericardial patch to the right of the pulmonary veins, so that the defect was closed and all the pulmonary venous blood was directed to the left atrium. The preoperative knowledge of the unusual anatomy allows the surgeon to repair the anomaly without difficulties. For the patients in whom interatrial communication and anomalous pulmonary venous return are suggested, surgeon has to pay careful attention to the anatomical landmarks to avoid incorrect placement of the patch.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.55-60
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• 2022

Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.337-341
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• 1996

A 40-year-old male patient who had ascending aortic pseudoaneurysm Involving right coronary artery obstruction and thoracic descending aortic pseudoaneurysm was successfully managed by two-stage operation. Repair of intimal tear of ascending aortic pseudoaneurysm with a patch of woven dacron vascular graft and right coronary artery bypass graft with great saphenous vein were performed in first stage operation. On 28 days postoperatively, Repair of intimal tear of descending aortic pseudoaneurysm with a patch of woven dacron vascular graft was done under the femorofemoral partial cardiopulri!onary bypass in second stage operation. The patient was discharged at postoperative 13th days without any evident.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.355-359
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• 1996

Rupture of the main bronchus due to blunt chest trauma is very rare, especially In childhood although the incidence is increasing. Early diagnosis and primary repair not. only restore normal lung function but also avoid the difficulties and complications associated with delayed diagnosis and repair. We experienced 2 cases of right main bronchial rupture caused by traffic accidents. Patients suffered from progressively developing dyspnea and subcutaneous emphysema on the neck, anteriorchest,andanteriorabdominalwall. Emergency operations were performed through right posterolateral thoracotomy incision at the 4th intercostal space. Intraoperatively, the right main bronchus completely transsected and separated. Corrective bronchoplasty was performed with end-to-end anastomosis using interrupted suture with 3-0 Vicryle and the suture line was reinforced with azygos vein and parietal pleural flap. Postoperative courses were uneventful and patients discharged without any specific pro lems.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.505-509
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• 1991

Rupture or laceration of the aorta is a more common result of nonpenetrating traumatic injury than is generally appreciated. If the lesion is promptly diagnosed, a appropriate surgical treatment may be life-saving. Diagnosis may be difficult and at times the rupture may remain clinically silent for variable period.< A 34 - year old male patient had sustained steering wheel injury to his chest during automobile accident 8 weeks prior to admission. The diagnosis of traumatic aneurysm of the aorta was delayed as he was asymptomatic. Surgical repair of false aneurysm of the descending aorta was successfully performed by partial cardiopulmonary bypass through the femoral artery and vein.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.340-349
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• 2007

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. In this study, vascular patency and thrombus formation in experimental micro-venous anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-venous anastomosis with heparin irrigation, all of 12 anastomosis site were good vascular patency. 2. In thrombus formation in 2 weeks group(Experimental I), 2 site of 6 cases were observed thrombus, and in 4 weeks group(Experimental II), 1 site of 6 cases were observed thrombus. 3. In histologic examination, normal vein(Control Group) showed continued internal elastic lamina, well formed thick smooth muscle layer and connective tissue. The group of 2 weeks after microvenous anastomosis(Experimental I) showd locally recovered internal lamina, discontinued internal lamina, disorganized smooth muscle cells and granulation tissue around suture silk. In the group of 4 weeks after micro-venous anastomosis(Experimental II), anastomosis site showed almostly continued internal lamina, disorganized smooth muscle cells and cicartrized tissue around suture silk. 4. In scanning electron microscope examination in 2 weeks(Experimental I) after micro-venous anastomosis, mesh fibrin formation showed near to endothelial cells, and in 4 weeks after micro-venous anastomosis(EXperimental II), numerous blood cells and fibrin mesh formation was seen associated with irregular endothelial cell arrangement. 5. In transmission electron microscope examination in 2 weeks after micro-venous anastomosis(Experimental I), irregular arrangement of smooth muscle cells was seen adjacent to collagenized tissue around suture silk. In 4 weeks after micro-venous anastomosis(Experimental II), denuded venous wall composed of relatively well arranged smooth muscle cells was covered by endothelial cells, but fibroblast cells and foreign body giant cells near to suture silk was remained. From the results obtained in this study, results of good vascular patiency and anti-thrombotic effect of heparin were obtained as a local irrigation solution, and repair of venous endothelial cell was observed in 2 weeks after micro-venous anastomosis.