Minimal Invasive cardiac Surgery: Small Submammary Incision / 대한흉부외과학회지

A cosmetic incision for minimal invasive cardiac surgery is described. Through a small submammary skin incision combined with partial low sternotomy some kinds of cardiac operations are possible without extra-difficulty but with excellent cosmetic effect, No special instruments nor techniques are required. By this method routine cannulations for cardiopulmonary bypass as well as aortic cross clamping bicaval snaring and venting of cardiac chambers are possible, We performed 5 cases of open heart surgeries using this approach which includes two cases of atrial septal defect closure one case of ventricular septal defect closure one case of pulmonic valvotomy and one case of mitral valve replacement.

Management of Post-Pneumonectomy Empyema / 대한흉부외과학회지

BACKGROUND: Post-pneumonectomy empyema(PPE) is an uncommon but a serious complication. The management remains as challenge for general thoracic surgeons. MATERIAL AND METHOD: During the period of January 1990 to December 1996, we evaluated the results of 20 patients with post-pneumonectomy empyema. RESULT: Sex ratio were 15 male and 5 female patients with mean age of 41.5+/-21.5 yrs. The occurrence ratio of left to right side was 8:12. The most common disease for prior pneumonectomy was pulmonary tuberculosis. The duration between pneumonectomy and PPE was variable in 1 month to 6yrs. Fever was the most frequent symptom and S. aureus was the most frequent pathogen. In 13 cases, there were combined with BPF. Four patients underwent trans-sternal closure, and Clagett procedure was performed. There was one recurrence that later underwent muscle plombage and omentopexy later. Nine patients underwent omentopexy, muscle plombage and thoracoplasty. There were 7 cases that were not combined with BPF. All 7 patients underwent thoracoplasty, and two of them were combined with muscle plombage. Mean follow-up duration is 40+/-32.3 months. There were no late deaths nor recurrences of PPE. CONCLUSION: We conclude that early diagnosis and proper drainage in PPE patients are important in its initial stage of management, and also management is completely achieved in thoracoplasty with muscle plombage or omentopexy.

Surgical Treatment of Funnel Chest / 대한흉부외과학회지

BACKGROUND: Funnel chest is one of the most common anomaly of chest wall, which is manifested by depression of sternum and costal cartilage. Popular operative methods were Ravitch operation and Wada operation. MATERIAL AND METHOD: From 1983 to 1996, 21 cases of funnel chest were corrected surgically in the department of thoracic surgery, National Medical Center. Investigated age and sex distribution, combined anomaly,clinical symptom, degree of correction and complication, postoperative satisfaction. We used 2 different surgical methods, one was Wada & its variants(17 cases), the other was Ravitch and it variants(4 cases). Most of operative indications were cosmetic problems. RESULT: The pre-operative Welch index was 4.188, but this index decreased to 3.46 after the operations.(p=0.046) The degree of correction was higher in Wada & it variant operation than the modified Ravitch operation.(p=0.54) Their results were satisfactory in 20 patients, while unsatisfactory in 1 patient because of a k-wire fracture. There was no recurrence of chest wall depression or postoperative death during the OPD follow up period. CONCLUSION: We recommend Wada operation in symmetric and small degree of depressive chest wall deformity in preand post school age.

Surgical treatment of Metastatic Lung Cancer / 대한흉부외과학회지

BACKGROUND: In spite of the development of chemotherapy, prognosis of metastatic lung cancer was poor. On the other hand, surgical intervention has proven itself to bring out superior results, therefore more operations are being praticed based on this superiority against chemotherapy and other modalities on metastatic lung cancer. MATERIAL AND METHOD: We analyzed the surgical cases performed from 1983 to 1997 on 17 cases and estimated 5 year survival rate using Kaplan-Meier method. RESULT: Average age was 42.8, ratio between male and female was 10:7. We had 8 single lobe resections,3 pneumonectomies,1 wedge resection,2 bilobectomy and 3 cases of lobar resection with wedge resection. 5 deaths have occured and among the 5, 3 patients were caused by recurrence of ca. The remaining 12 patients are being followed up in OPD basis among these, 3 recurrence were observed and 9 are still free of cancer. The average survival time was 40.5 months and 5 year survival rate obtained through the Kaplan-Meier method was 60.4%. CONCLUSION: Even though we are a bit short of cases, we recommend that a thoracic surgeon approach this disease through a surgical method as possibly as he could.

Bronchogenic Cyst Causing Mitral Regurgitation / 대한흉부외과학회지

Bronchogenic cyst is an uncommon congenital lesion which is derived from the primitive foregut. Most bronchogenic cyst may develope at the tracheal bifurcation, both main bronchi, the lung parenchymeand the mediastinum. A 40-year old male was evaluated for dyspnea and chest tightness. Computed tomography revealed a well dermarcated, 7.2 x 7.9 cm sized, homogeneous mass compressing the left atrium. 2D-echo showed grade III mitral regurgitation. We completely removed the cystic mass and then confirmed the bronchogenic cyst in the pathological diagnosis. During the follow up period, the patient progressed well without any symptoms and showed grade I mitral regurgitation on the 2D-Echo. Therefore, we report a case of the bronchogenic cyst causing grade III mitral regurgitation.

Surgical Angioplasty of the Left Main Coronary Artery Stenosis / 대한흉부외과학회지

BACKGROUND: Left main coronary artery (LMCA) angioplasty is another option in the surgical treatment for LMCA disease because of its advantages over the conventional coronary artery bypass grafting (CABG). MATERIAL AND METHOD: Between July 1994 and December 1997, 15 patients underwent left main coronary angioplasty for the stenoses of LMCA. There were 8 males and 7 females with the mean age of 53.3+/-8.8 years. The locations of the LMCA stenoses were proximal one-third of the LMCA in 9, middle one-third in 1, distal one-third in 3, and the whole length of the LMCA in 2 cases. Nine patients had peripheral coronary lesions in addition to the LMCA stenosis. The LMCA was approached anteriorly with or without transsection of the main pulmonary artery. The angioplasty was performed with onlay patch widening using an autologous pericardium (14 cases) or saphenous vein (1 case). Additional graftings were required in 9 cases, and both LMCA angioplasty and right coronary ostial angioplasty were done in 1 case. RESULT: There was no operative mortality. One case needed redo CABG due to the stenosis of the angioplasty site which developed 4 months postoperatively. Coronary angiography was performed in 8 cases one year postoperatively, and revealed good patency of the angioplasty site except for one who showed 50% stenosis at the angioplasty site. No patient complained of angina with a mean follow up of 23+/-11 months. CONCLUSION: Surgical angioplasty of the LMCA stenosis can be performed in selected cases with safety and good mid-term results.

An Anomalous Left Upper Pulmonary Venous Connection Associated with ADS ( Atrial Septal Defect ) / 대한흉부외과학회지

Partial anomalous pulmonary venous connection is frequently found in any ASD(atrial septal defect) patients. These patients are usually symptomatic, therefore, easily diagnosed as just simple ASD. We experienced a case of a 37-year-old female patient with ASD in which the left upper pulmonary vein was connected to SVC by the left inominate vein. The patient was diagnosed as simple ASD previously. During cardiac catheterization, we found a meaningful oxygen saturation step up between the SVC and its upper portion. Angiogram confirmed PAPVC. The surgical correction of anastomosis of PAPVC with left atrial appendage and direct closure of ASD were done. The patient was discharged 15 days later.

Esophageal Stent in Postpneumonectomy Esophagopleural Fistula / 대한흉부외과학회지

A case of esophagopleural fistula after pleuropneumonectomy is reported. A 59 years old male underwent right pleuropneumonectomy due to tuberculous empyema. The postoperative small esophagopleural fistula was confirmed by esophagogram and was initially managed by a conservative treatment. There was a persistent fistula on follow up esophagogram, therefore we planned the next treatment modality for obstruction of the fistula. For poor general conditions and arrhythmia, an esophageal stent was applied as a non-surgical method. At first, a covered-form stent was inserted, but it migrated to the stomach after 3 months. By using an uncovered-form stent, a complete obstruction of the esophagopleural fistula was achieved.

Surgical Treatment of Esophageal Stricture in Barrett's Esophagus: A Case Report / 대한흉부외과학회지

A casts of Barrett's esophagus complicated with stricture is reported. A 82 years old male was undergone distal esophagectomy and esophagogastrostomy on suspicion of malignancy. The microscopic examination of specimen taken from the lesion revealed the "tall columnar cells" which were indicative of Barrett's esophagus, hence the diagnosis. Barrett's esophagus is a rare disease in Korea. Because of the malignant potential of the disease, surgery involving esophagectomy is often required.