• Journal of Chest Surgery
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• v.34 no.4
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• pp.296-304
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• 2001

배경: 이번 연구의 목적은 체내이식형 양심실 보조장치의 개발을 위한 안전하고 간편한 동물실험 모델을 확립하는 것이며 이동작동형 완전 인공심장의 양심실 보조장치로의 사용 가능성을 알아보는 것이다. 대상 및 방법: 7마리의 Corridale 양을 대상으로 실험하였다. 5번째 늑간극을 통하여 좌측 개흉술을 시행하고 좌측 유출로 캐뉼라는 하행 대동맥에 Dacron graft을 사용하여 연결하였고 유입로 캐뉼라는 좌심방에 삽입하였다. 우측 유출로 캐뉼라는 하행 대동맥과 같은 방법으로 주폐동맥에 연결하였으며 유입로 캐뉼라는 혜동맥을 하방으로 젖혀 우심방이를 노출시킨 다음 우심방이에 삽입하였다. 4마리에 있어서는 양심실 보조장치를 전복막강(preperitoneal space)에 위치시켰으며 2마리에 촤측흉강 내에, 1마리에서는 외부에 위치시켰다. aPTT는 수술전 aPTT의 2∼2.5배로 맞추어 주었다 결과: 수술중 또는 수술직후 사망한 경우는 없었으며 7마리 모두 인공호흡기 이탈이 가능하였고 스스로 기립하고 음식물 섭취도 가능하였다. 1마리는 술후 2일째 혈전 색전증 및 인공호흡기 작동 잘못으로 사망하였으며 2마리의 겨우는 술후 2일째 각각 양심실 보조장치의 작동 잘못 및 호흡부전으로 사망하였고, 3마리의 경우는 술후 4일째 혈전색전증으로 인한 급성신부전 및 호흡부전 등으로 사망하였다. 1마리에 있어서는 28일간 생존하였으며 양심실 보조장치의 구동 장치에 연결된 라인의 마로로 인해 양심실 보조장치의 작동이 정지되었으나 바로 양심실 보조장치를 제거하고 살릴 수 있었다. 모든 경우에 있는 캐뉼라를 삽입하고 양심실 보조장치를 작동시키는데 큰 어려움이 없었다. 7마리 중 4마리에서 혈전이 발견되었으며 특히 판막을 연결한 부위에 혈전생성이 많았다. 그러나 캐뉼라에는 혈전생성이 없었다. 결론: 양에 있어서 좌측 개흉술 및 전복막강 공간에 양심실 보조장치를 위치시키는 이번 동물실험 모델은 체내 이식형 양심실 보조장치 개발을 위한 좋은 동물실험 모델이라고 생각된다. 또한 디동 작동기형 완전 인공심장의 혈전생성을 억제할수 있는 방법들의 연구개발이 지속된다면 장기간의 체내 이식형 양심실 보조장치로 사용할 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.329-335
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• 2002

Background: The surgical technique for biventricular assist device(BVAD) implantation has mainly consisted of cannulation procedures. A median sternotomy has been the technique of choice as it gives a surgeon an excellent exposure of the heart. However, considering that most patients require a future sternotomy or already have a previous sternotomy, sternotomy-related complication remains a major concern in BVAD implantation. Based on this consideration as well as the clinical experiences of conventional heart surgery, the authors have hypothesized that the cardiac chambers for BVAD cannulation can be approached from the right side of the heart. The purpose of this studs to develop a novel surgical technique of right thoracotomy for BVAD implantation in an animals study. Material and Method: For last two years, 16 (11 calves, 3 canines, and 2 sheep) out of 30 experimental animals with AnyHeart implantation underwent a right thoracotomy. The device was used as an implantable BVAD in 14 animals, a wearable BVAD in 1, and an implantable LVAD in 1. The chest cavity was entered through the 4th intercostal space or the 5th periosteal bed. As for the BVAD use, a right inflow cannula was inserted into the right atrial free wall and a right outflow cannula was grafted onto the main pulmonary artery. A left inflow cannula was inserted into the interatrial groove and a left outflow cannula was grafted on the innominate artery of the ascending aorta. The connecting tubes were brought out through the thoracotomy wound and connected to the pump located in the subcutaneous pocket at the right flank. Result: Except for the 5 animals for a lilting test or during the early learning curve, all recovered smoothly from the procedures. The inflow drainage allowed the pump output 6.5 L/min at the maximum with 3-3.5 L/min in an average. Of the survivors, there noted no procedure-related mortality or morbidity. Necropsy findings demonstrated the well-positioned cannula tips in the each cardiac chamber

• Journal of Chest Surgery
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• v.35 no.4
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• pp.322-324
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• 2002

Herein we report a rare case of primary esophageal malignant melanoma in a 56-year-old gentleman who presented with a 2-month dysphagea. Esophagoscopy reveals a polypoid tumor and a total thoracic esophagectomy was performed through a right thoracotomy and esophageal replacement with stomach. The tumor was proven to be a primary esophageal malignant melanoma by histological and immunohistochemical studies. The pathologic stage was IIa. He received no postoperative adjuvant therapy. He died of liver metastasis at 8 months postoperatively.

• 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.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.155-158
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• 2007

A congenital diaphragmatic hernia, which mainly occurs in the left thorax, requires an emergency operative procedure during the neonatal periods. A right-sided congenital diaphragmatic hernia is rare, and often detected after the neonatal period due to the mild symptoms. Traditionally, the treatment repairs the diaphragmatic defect via a thoracotomy. However, good results of thoracoscopic repairs have been reported. Herein, the case of a 5-month-old girl, who received a thoracoscopic repair of a right-sided congenital diaphragmatic hernia, is reported.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.624-628
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• 1998

Postpneumonectomy syndrome is a rare and delayed complication of left pneumonectomy in most patients with normal mediastinal vascular anatomy. This syndrome is characterized by dyspnea and recurrent pulmonary infection in the remaining right lung that typically occur within the first postoperative year. The condition is believed to be secondary to postsurgical changes that include a marked shift of the mediastinum to the left, clockwise rotation of the heart and great vessels, and herniation of the right lung into the left anterior thorax. These changes lead to compression of the trachea or right main bronchus among the thoracic spine and the right pulmonary artery. We report a case of postpneumonectomy syndrome in 15 year-old girl that followed by left pneumonectomy for bronchiectasis 6 years ago. We have inserted an expandable prosthesis in the left thoracic cavity posterior to the heart. After implantation of an expandable prosthesis, an anatomic reposition of the shifted mediastinum was achieved, which resulted in instantaneous and sustained relief. The post-operative course was uneventful and the patient was followed in OPD from after discharge to now.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.226-230
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• 1997

This is a case report of surgical management of a bilateral intralobar pulmonary sequestration with horseshoe lung presenting with frequent U I with productive sputum. Simple chest X-ray showed pneumonic consolidation and infiltration on both lower lobes, and chest CT revealed multiple cystic lesions compatible with pulmonary sequestration. The aortography demonstrated two anomalous systemic arteries arising from the thoracic aorta just above the diaphragm to both sequestrums. Left lower lobectomy was performed through the left thoracotomy with ligations and divisions of the both systemic feeding arteries to the left and right sequestrum, and division of the isthmic portion of horseshoe lung without removal of right sequestrum. The patient was discharged on the postoperative loth day and followed-up till now without any sequelae and symptoms of residual right sequestration. The recent follow-up chest CT 5 months after the operation revealed spontaneous regression of the residual right sequestrum. Authors would suggested that only division of aberrant artery to sequestrum without lobectomy may be applied in uncomplicated ca e of intrapulmonary seqilestration.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.282-285
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• 2004

Aberrant right subclavian artery (ARSA) is an anomaly with a reported incidence of 0.5% to 2%. Most patients with an ARSA remain asymptomatic; however about to% of adult patients have compressive symptoms. A case is reported of a 64-year old female patient who had a few years of history of dysphagia and recurrent pneumonia. Angiography was performed, which demonstrated an ARSA with common origin of the right and left carotid arteries. Surgical correction was performed via right thoracotomy. The proximal aberrant artery was mobilized behind the esophagus. The distal, right subclavian artery was exposed, transected, and transposed with reimplantation into the aortic root by graft bypass.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.589-593
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• 2005

Esophageal schwannoma is very rare and almost of all cases are diagnosed as esophageal submucosal tumor preoperatively. Final diagnosis is made by postoperative immunohistochemical (IHC) staining of the surgical specimen. We experienced two cases of esophageal submucosal tumor, one was 63 year old female suffering from three months of dysphagia and another was 39 year old female complaining of two months of intermittent dysphagia. Two esophageal tumors were completely removed by esophagectomy and enucleation through right thoracotomy respectively. Postoperative IHC staining demonstrated S-100 positive without mitotic figures and confirmative diagnosed was made as benign esopphageal schwannoma.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.711-714
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• 2007

Phlegmonous esophagitis is a disorder in which bacterial infection occurs in the submucosal and muscular layers of the esophagus. This malady is very rare and it is usually associated with high mortality. A 69-year-old male was admitted with chest pain and fever he'd experienced for 7 days. The chest computerized tomography scan revealed mediastinal widening, circumferential esophageal thickening, an air shadow along the esophagus and right pleural effusion. Drainage and debridement of the mediastinum and primary repair of the perforated esophageal muscular layer through a right thoracotomy was done immediately. Further surgical treatment was not performed. He had a good oral intake without dysphagia or esophageal leakage at discharge.