• Journal of Chest Surgery
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• v.24 no.2
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• pp.217-221
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• 1991

Bronchiectasis is bilateral in approximately 30% of patients. Although the presence of bilateral bronchiectasis was frequently considered a contraindication to surgical resection due to excessive loss of functional pulmonary parenchyma, it is a correct view that the involved broncho-pulmonary segments are functionless and risks to the as yet uninvolved segments and should be removed if the patient`s pulmonary function is tolerable. We report a case of multisegmental bilateral bronchiectasis treated by bilateral simultaneous pulmonary resection through a median sternotomy. Five bronchiectatic segments were resected, which were right middle lobe, anterobasal segment of the right lower lobe, and lingula of the left upper lobe.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.356-360
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• 2016

Background: The standard approach in treating cardiac myxoma is the median full sternotomy. With the evolution of surgical techniques, the right minithoracotomy approach has emerged as an alternative method. Since few studies have been published assessing the right minithoracotomy approach, we performed a retrospective study to compare the clinical outcomes of the right minithoracotomy approach with those of the sternotomy approach. Methods: From January 2005 to December 2014, 203 patients underwent resection of a cardiac myxoma. Patients with preexisting cardiac problems were excluded from this study. 146 patients were enrolled in this study; 83 patients were treated using a median sternotomy and 63 patients were treated using a right minithoracotomy. Results: No early mortalities were recorded in either group. Although the cardiopulmonary bypass time and aorta cross-clamp time were significantly shorter in the sternotomy group (p<0.001 and p=0.005), postoperative blood transfusions and arrhythmia events were significantly less common in the thoracotomy group (p=0.004 and p=0.025, respectively). No significant differences were found in the duration of the hospital stay, postoperative intubation time, the duration of the intensive care unit stay, and recurrence. Conclusion: The minimally invasive right minithoracotomy approach is a good alternative method for treating cardiac myxoma because it was found to be associated with a lower incidence of postoperative complications and a shorter postoperative recovery period.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.675-679
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• 2002

In patient with severe adhesion between lung and aorta, there is some limitation in approaching the distal arch or descending thoracic aorta through the usual left thoracotomy. We report a case of a successfully managed distal arch and descending thoracic aortic aneurysm through the median sternotomy without any manipulations of the lung in a 66 year old man who presented hemoptysis.

• Journal of Chest Surgery
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• v.49 no.6
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• pp.421-426
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• 2016

Background: Median sternotomy is the standard approach for atrial septal defect (ASD) closure. However, minimally invasive cardiac surgery (MICS) has been introduced at many centers in adult/grown-up congenital heart patients. We retrospectively reviewed the results of right anterolateral thoracotomy compared with conventional median sternotomy (CMS) for ASD closure at Seoul National University Hospital. Methods: We retrospectively analyzed 60 adult patients who underwent isolated ASD closure from January 2004 to December 2013 (42 in the CMS group, 18 in the MICS group). Preoperative, operative, and postoperative data were collected and compared between the 2 groups. Results: The MICS group was younger (44.6 years vs. 32.4 years, p=0.002) and included more females (66.7% vs. 94.4%, p=0.025) than the CMS group. Operation time (188.4 minutes vs. 286.7 minutes, p<0.001), cardiopulmonary bypass time (72.7 minutes vs. 125.8 minutes, p<0.001), and aortic cross-clamp time (25.5 minutes vs. 45.6 minutes, p<0.001) were significantly longer in the MICS group. However, there were no significant differences in morbidity and mortality between groups. Only chest tube drainage in the first 24 hours (627.1 mL vs. 306.1 mL, p<0.001) exhibited a significant difference. Conclusion: MICS via right anterolateral thoracotomy is an alternative choice for ASD closure. The results demonstrated similar morbidity and mortality between groups, and favored MICS in chest tube drainage in the first 24 hours.

• Journal of Chest Surgery
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• v.14 no.3
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• pp.215-217
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• 1981

• Journal of Chest Surgery
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• v.27 no.9
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• pp.793-797
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• 1994

Constrictive pericarditis is often accompanied with ~brothorax and deterioration of cardiac, hemodynamic functions. Surgical relief of fibrous peel causes remarkable improvement in pulmonary, cardiac, hemodynamic function, and subjective symptoms. We experienced 4 cases of constrictive pericarditis combined with bilateral ~brothorax after bilateral pleural effusion caused by tuberculosis and non-specific inflammation. Pleural decortication and pericardiectomy were done at the same time through anterolateral thoracotomy with sternal transection[3 patients] and median sternotomy incision[l patient]. Low cardiac output was the most common complication. With left anterolateral thoracotomy, we could prevent the hypotension from massive retraction for dissecting by median sternotomy, which was good for dissecting from anterior wall of left ventricle to posterior wall of left ventricle and surrounding phrenic nerve. It was enough to dissect the portion being through hard to dissect, right atrium, SVC and IVC.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.1015-1018
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• 1997

Median sternotomy incision is world-widely used for open heart surgery, especially in valvular heart disease. But recently, minimally invasive approach by the right parasternal incision for valvular heart disease was introduced with the many merits by small incision. We experienced 1 case of mitral valve repalcement by right parasternal incision and extended transseptal approach. This technique has no specific compli ations or problems compared with the median sternotomy and was proven by the excellent exposure. Cosmetically, the patient was satisfied with the incision.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.522-526
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• 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 Trauma and Injury
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• v.21 no.2
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• pp.136-139
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• 2008

A great variety of penetrating injuries is happening due to the increasing population and violence today. An optimal surgical approach is the key factor for successful repair of a complicated penetrating injury. A 23-year-old woman fell down the stairs from the second floor and received cervico-thoracic penetration injury due to a metalic bar. The metalic bar ruptured the right jugular vein and penetrated the left upper and lower lung. Under cervico-median sternotomy, neck vessels were repaired and the left thorax was successfully entered to repair the damaged lung through the mediastinal pleura. With this approach, the patient's position did not need to be changed during operation, while reduced the operation time compared to the conventional approach (cervical incision and standard thoracotomy).

• Journal of Chest Surgery
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• v.33 no.1
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• pp.20-25
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• 2000

Background: Median sternotomy remains the standard approach used by surgeons for most intracardiac operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline scar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. Material and Method: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with vertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde study about postoperative wound states comparing this incision with median sternal skin incision controls in whom there were 23 pediatric pat-ients (control group). Result: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.