Sternotomy For Repair Research Articles

Comparison of Thoracotomy and Sternotomy Repair in Neonatal Aortic Coarctation Surgery: A Single Center Experience

Comparison of Thoracotomy and Sternotomy Repair in Neonatal Aortic Coarctation Surgery: A Single Center Experience

Current Activity Guidelines for CABG Patients are too Restrictive: Comparison of the Forces Exerted on the Median Sternotomy during a Cough vs. Lifting Activities Combined with Valsalva Maneuver

The current activity guidelines for coronary artery bypass graft surgery (CABG) patients are overly restrictive, hindering recovery. As the sternotomy repair must withstand repeated coughs during convalescence, this provides a benchmark for the force tending to separate the incision that can be tolerated. Nine volunteers performed 5 weightlifting activities (lifting 5 lbs [2.3 kg], lifting a 25-lb simulated grandchild [11.4 kg], lifting a 30-lb suitcase [13.6 kg], lifting two 20-lb weights [18.2 kg], and lifting a gallon of milk to a counter [3.7 kg]), plus coughing. Valsalva forces were detected using a mouthpiece configured with an Ashcroft Inc. expiratory pressure gauge (model N10-120CMW). Three measurements were taken for each activity to calculate the mean internal forces while external forces on the sternotomy were calculated using vector algebra. Total force exerted on the sternotomy by the cough was compared to the total force exerted by each of the 5 activities using paired T-tests. The cough exerted a significantly greater force across the median sternotomy (mean 27.5 kg-mass) than any of the five weightlifting activities ( P < 0.05). The greatest difference was observed was for lifting a 5-lb weight (22.5 kg-mass), and the smallest for lifting two 20-lb weights (4.4 kg-mass). Lifting even 40 lbs puts less force on the median sternotomy incision than a cough. The strength of the repair is significantly greater than is implied by the recommendation to "not lift more than 5 lbs".

Totally endoscopic subxiphoid pericardioscopy: early steps with a new surgical tool

Pericardial pathology still has challenging diagnostic and treating issues. To reduce surgical trauma and pain for the patient, the authors developed a totally endoscopic echo-guided approach for both diagnostic and operative pericardioscopy. Three steps moved from animal model (8 pigs) through concomitant open-chest interventions (7 patients) to closed-chest interventions for 10 patients with a diagnosis of severe pericardial effusion. A lesion of the right ventricle in one patient (10%) due to imperfect preoperative pericardial visualization needed sternotomy for repair. All the patients, except the aforementioned one, underwent surgery with local anesthesia or mild sedation. No method-related mortality was reported. The closed-chest nonintrapleural approach to the pericardium may represent an evolution, with a positive impact on the treatment of this pathology. Therapeutic maneuvers with rigid instruments in nonintubated patients are possible. Accurate patient selection and technical refinement should increase the safety and effectiveness of the method.

Combined Zone I and II Neck Injury Requiring Median Sternotomy for Repair

Combined Zone I and II Neck Injury Requiring Median Sternotomy for Repair

Right Anterolateral Thoracotomy for Repair of Atrial Septal Defects in Young Female Patients

We performed a right anterolateral thoracotomy for atrial septal defect closure in young female patients to achieve a good cosmetic result. From December 1995 to June 1997, 25 female patients with a mean age of 10 ± 3 years (range, 4 to 22 years) underwent repair of atrial septal defects that comprised 24 ostium secundum and one sinus venosus. The length of the incision varied from 10 to 14 cm. The ascending aorta was used for arterial cannulation except in 2 cases where the external iliac artery was cannulated. Repairs were performed under crystalloid cardioplegia except in 2 patients where fibrillation was employed. In 5 patients, autologous glutaraldehyde-treated pericardial patch closure was used and the defects were closed directly in the other 20. All patients underwent echocardiography in the intensive care unit and 3 months after the repair. There was no operative or late mortality and no morbidity related to the thoracotomy approach. We concluded that a right anterolateral thoracotomy incision is a safe and effective alternative to a median sternotomy for repair of atrial septal defects and it provided a superior cosmetic result in these young female patients.

Inflammatory pseudotumor of the sternum; a complication of polymer application during sternotomy repair

Inflammatory pseudotumor of the sternum; a complication of polymer application during sternotomy repair

Inflammatory pseudotumor of the sternum: A complication of polymer application during sternotomy repair

A case of inflammatory pseudotumor of the sternum resulting from the application of polyurethane foam is discussed. The past use of polymers in bone repair is reviewed.