• Journal of Chest Surgery
• /
• v.35 no.5
• /
• pp.329-335
• /
• 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
• /
• v.43 no.6
• /
• pp.648-654
• /
• 2010

Background: This study assessed the early results of endovascular repair of acute type B aortic dissection and the aortic wall changes following endovascular repair. Material and Method: From July 2008 to May 2009, the preoperative and follow-up computed tomography (CT) scans of 5 patients with acute type B aortic dissection were evaluated, and these patients had underwent stent graft implantation within 13 days of the onset of dissection (mean: 7 days; range: 3~13). The whole lumen (WL), true lumen (TL) and false lumen (FL) diameters were measured at the proximal (p), middle (m) and distal (d) third of the descending thoracic aorta. Result: The study included four men and one woman with an average age of $59.4{\pm}20.1$ years (age range: 37~79 years). The follow-up CT was performed and evaluated at 7 days and 6 months. The primary tear was completely sealed in all the patients. No paraplegia, paresis or peripheral ischemia occurred and none of the patients died. No endoleaks developed in any of the patients during follow-up. The TL diameters increased from 20.4 to 33.5 mm in the proximal third (p/3), from 19.5 to 29.8 mm in the middle third (m/3) and from 15.2 to 23.5 mm in the distal third (d/3). The FL diameters decreased from 18.7 to 0 mm in the p/3, from 15.4 to 0 mm in the m/3 and from 21.4 to 8.7 mm in the d/3. The changes in the TL diameter were statistically significant in the middle and distal aorta, and those changes in the FL diameter were not statistically significant. There was a decrease in the WL after repair, but this was not statistically Significant. In three patients, the false lumen disappeared completely on follow-up CT at 6 months. Two patients had patent false lumens and no thrombosis. Conclusion: The early results showed that endovascular repair was effective in treating acute type B aortic dissection, and endovascular repair promoted positive aortic wall changes.

• Journal of Chest Surgery
• /
• v.47 no.2
• /
• pp.111-116
• /
• 2014

Background: We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department. Methods: Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma. Results: The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted. Conclusion: Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.

• Journal of Chest Surgery
• /
• v.53 no.5
• /
• pp.301-305
• /
• 2020

Background: Radiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC. Methods: The medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed. Results: Based on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60). Conclusion: Based on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.

• Journal of Chest Surgery
• /
• v.42 no.2
• /
• pp.272-274
• /
• 2009

Xiphodynia is a term used to describe a painful xiphoid process, and this is a rare musculoskeletal disorder that can radiate to the anterior chest, epigastrium, neck, shoulders and back. Clinical awareness of xiphodynia is important for making its correct diagnosis. We report here on two cases of xiphodynia. The diagnosis was suggested by the reproduction of the anterior chest pain or/and the epigastrium pain with light pressure on the xiphoid process. The patient of case 1 had suffered from xiphodynia throughout the years, and this patient underwent surgical excision of the xiphoid process. The patient of case 2 received an injection of local anesthetic agent to the xiphoid process.

• Journal of Chest Surgery
• /
• v.45 no.3
• /
• pp.161-165
• /
• 2012

Background: Median sternotomy can weaken the upper abdominal wall and result in subxiphoid incisional hernia. We evaluated risk factors associated with the development of subxiphoid incisional hernias after coronary artery bypass grafting (CABG). Materials and Methods: Of 1,656 isolated CABGs performed between January 2001 and July 2010, 1,599 patients who were completely followed up were analyzed. The mean follow-up duration was $49.5{\pm}34.3$ months. Subxiphoid incisional hernia requiring surgical repair developed in 13 patients (0.8%). The hernia was diagnosed $16.3{\pm}10.3$ months postoperatively, and hernia repair was performed $25.0{\pm}26.1$ months after the initial operation. Risk factors associated with the development of subxiphoid incisional hernia were analyzed with the Cox proportional hazard model. Results: Five-year freedom from the hernia was 99.0%. Univariate analysis revealed that female sex (p=0.019), height (p=0.019), body surface area (p=0.046), redo operation (p=0.012), off-pump CABG (p=0.049), a postoperative wound problem (p=0.041), postoperative bleeding (p=0.046), and low cardiac output syndrome (p<0.001) were risk factors for the development of the hernia. Multivariable analysis showed that female sex (p=0.01) and low cardiac output syndrome (p<0.001) were associated with subxiphoid hernia formation. Conclusion: Female sex and postoperative low cardiac output syndrome were risk factors of subxiphoid hernia. Therefore, special attention is needed for patients with high-risk factors.

• Journal of Trauma and Injury
• /
• v.28 no.3
• /
• pp.219-221
• /
• 2015

Subclavian injuries in blunt trauma are reported in less than 1% of all arterial injuries or chest related injuries. We report a female 68 yr-old patient whom has visited our emergency center due to a motorcycle traffic accident with complaints of right chest wall and shoulder pain. Her injury severity score was 22 and she was found with a comminuted clavicle fracture and subclavian artery injury. She developed delayed symptoms of pallor, pain and motor weakness with loss of pulse in her right arm. Attempts at intervention failed and thus, she underwent emergency artificial graft bypass from her subclavian artery to her brachial artery. Her postoperative course was uneventful and she is happy with the results. Although rare, a high index of suspicion for the injury must be noted and the inevitable surgical option must always be considered.

• Journal of Chest Surgery
• /
• v.7 no.2
• /
• pp.169-174
• /
• 1974

Duplication of the alimentary tract, especially of the esophagus, have been regarded as rare cong- enital anomalies. However, they are being reported with increasing frequency in the literature. In the . ,- past they have been described by a variety of names, such as "enteric cysts", "intestinal cysts", "giant diverticula", "`mediastinal cysts of foregut origin" "enterogenous cysts" and other descriptive terms. . Most authorities now agree that these anomalies are best described by the term "duplications of the alimentary tract. The duplications [of the alimentary tract] are spherical or tubular structures which poses a well developed smooth muscle layer and are lined with a mucous membrane from any part of the alimentary tract. They may occur at any place in the digestive tube from the tongue to the rectum and usually are intimately attached to some portion of the alimentary tube. We have experienced a duplication of the esophagus in 14 years old middle schoolboy. He complained dysphagia, eructation and substernal pain associated with intermittent high fever and chilliness, increasing in severity for recent three weeks. Routine chest X-ray film revealed nore markable abnormal finding but esophagogram. revealed marked narrowing of the esophagus throughout with a large blind pouch in lower half with fistulous communication at mid portion of the esophagus. On thoracotomy, a large infected blind pouch communicating with the lumen of normal esophagus proximally, Was extended from the level of 5th to 10th thoracic spine. The duplicated segment of the esophagus has a common muscular .wall and proximal communication with the adjacent esophagus. The infected, duplicated esophagus was segmentally resected, and esophagogastrostomy with pyloroplasty was done by displacing the stomach into the right thoracic cavity through midline laparotomy. His Postoperative course was uneventful and discharged without complication.

• Journal of Chest Surgery
• /
• v.39 no.9 s.266
• /
• pp.729-732
• /
• 2006

Mediastinal teratoma is one of the most common lesions found in the anterior mediastinum, accounting for $8\sim13%$ of all mediastinal tumors. This tumor is incidentally detected by routine chest roentgengography, but pericardial perforation or pleural effusion occurs rarely. In our patient cardiac tamponade was developed due to anterior chest wall contusion, we confirmed the anterior mediastinal tumor. Vital signs were stabilized after the pericardiocentesis, and the patient underwent the tumor resection in the anterior mediastinum for a definite treatment. On histologic examination, the tumor revealed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, gastrointestinal mucosa, respiratory epithelium, and pancreatic tissues.

• Journal of Chest Surgery
• /
• v.8 no.1
• /
• pp.51-56
• /
• 1975

The typical traction diverticulum of the mid-thoracic esophagus is conical or funnel shaped with a wide orifice, is small (rarely exceeding 2cm in length), and is situated horizontally or extends superiorly. It is a true diverticulum, having a complete investment by the esophageal muscle coats. Each of these characteristics promotes easy emptying of the diverticulum. Since food accumulation is presented, there is no tendency to progressive enlargement of the sac, and no associated dysphagia. The diverticula of mid-esophagus rarely develop and rarely produce symptoms. When symptoms develop, they are usually caused by granulomatous infections of the mediastinal lymph nodes. And also such diverticula only rarely give rise to significant complications, the most serious of which is a tracheobronchial fistula. Generally when such complications develop or a diverticulum itself produces symptoms, moderate or severe, surgery intervenes. A case of mid-esophageal diverticulum, traction type, which surgically treated with good results, was experienced at the Department of Thoracic Surgery of Kyung-Pook University. School of Medicine. In this case, there were substernal discomfort, acid regurgitation, and back pain for about 6 months. On the operative findings, it was noticed that the diverticulum was developed by traction and adhesion of perihilar nodes to the esophageal wall. The diverticulum was a small finger tip size and the neck of it was obscure. The surrounding inflammatory change was minimal.