Free Flow in Internal Thoracic Artery and Internal Thoracic Artery-Radial Artery Composite Graft / 대한흉부외과학회지

BACKGROUND: The Y-composite graft of internal thoracic artery and radial artery is commonly used in coronary bypass surgery. The aim of this study is to look for a way to raise the free flow of the internal thoracic graft and to see flow dynamics of the Y-graft. MATERIAL AND METHOD: In 15 patients undergoing coronary bypass surgery, free flow of the in-situ internal thoracic artery graft was measured using two different papaverine application methods; extraluminal papaverine spray in 7 patients and intraluminal papaverine injection in 8. In 18 other patients for whom the Y-graft was used, total free flow and flow changes from the two ends were measured. RESULT: The free flow of the in-situ internal thoracic artery graft almost doubled with internal papaverine injection than with external papaverine spray (47.7+/-9.6 mL/min vs. 100.8+/-26.3 mL/min, p<0.001). Total flow of the Y-composite graft was significantly more than either flow of the internal thoracic artery end or radial artery graft end (173.3+/-45.3 mL/min vs. 121.1+/-34.3 mL/min or 117.5+/-42.8 mL/min). When both ends of the Y-composite graft were opened, free flows from the two ends were similar (85.4+/-27.8 mL/min vs. 87.9+/-42.4 mL/min, p=0.772). The flow of one end of the Y-composite graft was increased significantly by clamping of the other-end than when both ends were opened. CONCLUSION: Intraluminal papaverine injection is very effective in raising free flow of the internal thoracic artery graft, and the free flow of the Y-composite graft of in-situ internal thoracic artery and free radial artery graft is more than that of the in-situ internal thoracic artery graft. The flow of one end flow of the Y-graft may be altered by the flow change of the other end.

Effect of Sternal Closure Method on Sternal Dehiscence With or Without Infection / 대한흉부외과학회지

BACKGROUND: The most important factor in preventing sternal complications is stable sternal approximation. We have tried to find the most effective sternal closure method by examining the incidence of sternal dehiscence with or without infection in patients with cardiac surgery through median sternotomy. MATERIAL AND METHOD: This study was performed in 489 patients over 45 years of age with median sternotomy for open cardiac surgery. Simple closure with interrupted 6 wires was performed in 159 patients, figure-of-8 closure technique in 119, overlapping interrupted closure using 10 wires in 150, and combined closure technique of interrupted simple closure and figure-of-8 suture closure in 61. Two hundred thirty-four patients underwent valve and aortic operations and 213 patients coronary artery bypass surgery. RESULT: Sternal dehiscence with or without infection occurred in 12 (2.5%) patients. The complication developed in 5 of 159 patients (3.1%) with six interrupted simple closure, in 4 of 119 patients (3.4%) with figure-of-8 closure, and in 3 of 150 patients (2.0%) with overlapping interrupted closure using 10 wires, but there was no complication in 61 patients with combined closure technique (relative risk for other closure techniques, p<0.05). There was no significant difference in the incidence of the sternal complication between valve and aortic operation group and coronary artery bypass group (3.0% vs 2.3%, not significant), but diabetes mellitus was a significant independent risk factor (odds ratio and multivariate analysis, p<0.05). CONCLUSION: The sternal closure technique that combines simple interrupted suture closure and figure-of-8 suture closure may be a more useful technique to enhance sternal stabilization compared to other closure techniques, such as simple interrupted closure, 8-figure closure, and overlapping interrupted closure.

Surgical Removal of a Pedunculated Left Ventricular thrombus / 대한흉부외과학회지

A 53-year-old male patient who had suffered from acute myocardial infarction before a week was admitted due to postinfarction angina A mobile pedunculated left ventricular thrombus of 2.0-cm diameter which was overlooked in cardiac catheterization and ventriculographic study was diagnosed with transthoracic two-dimensional echocardiography. There was no exact clinical finding of left ventricular aneurysm and the thrombus was placed in the akinetic and hypokinetic apical portion. For preventing systemic embolism that was removed through a left ventriculotomy just prior to coronary artery bypass grafting.

Mid-term Result of Operations for Atrial Fibrillation / 대한흉부외과학회지

BACKGROUND: Majority of patients with mitral valve disease and chronic atrial fibrillation can resume sinus rhythm with the maze procedure. The purpose of this study is to identify mid-term outcome and possibility of recurrent atrial fibrillation in the patients who underwent mitral valve operation and the maze procedure. MATERIAL AND METHOD: A retrospective study was undertaken on 11 consecutive patients(including 10 patients with rheumatic mitral valve disease) operated on for mitral valve disease and chronic atrial fibrillation. Maze II and its modified procedure were performed in 6 patients and maze III and its modified procedures in 5 patients. Postoperative left atrial contractility was compared between the patients that underwent mitral valve operation and maze procedure and the patients with mitral valve procedure and medication of anti-arrhythmic drugs. RESULT: Five(83.3%) of 6 patients with maze II procedure and all 5 patients(100%) with maze III procedure resumed sinus rhythm. In 1(20%) of 5 patients with sinus rhythm after maze II procedure and 2(40%) of 5 patients with sinus rhythm after maze III procedure, atrial fibrillation recurred 23, 2, and 13 months after the operations, respectively. None of three patients with the modified procedure had recurrence of atrial fibrillation. Of 3 patients with recurrent atrial fibrillation, 2 patients resumed sinus rhythm and 1 still had atrial fibrillation. After the maze procedures, only 4 (40%) of 10 patients with sinus rhythm presented left atrial contraction, and their mean velocity of mitral 'A' wave was lower than that of the patients who resumed sinus rhythm with only valve replacement and anti-arrhythmic drugs. CONCLUSION: Although the maj ority of patients with mitral valve disease and chronic atrial fibrillation can resume sinus rhythm with the maze procedure associated with mitral valve operation, atrial fibrillation may recur in mid-term. Also, the left atrial contractility may be very poor in patients who resumed sinus rhythm with maze procedure.

Primary malignant Fibrous Histiocytoma (MFH) of Pleura: A case report / 대한흉부외과학회지

Primary malignant fibrous histocytoma (MFH) of pleura is very rare. Upon microscopic examination, the tumor was characterized by storiform pattern of growth and intense, diffuse immunostaining for alpha l-antichymotripsin. We report a case of primary malignant pleural fibers histiocytoma with extension to lung, which was managed by complete excision of pleural mass and lobectomy with thoracoplasty.