Traditional cardiac surgery has been performed via a "big" median sternotomy incision by significant complexity and invasiveness. The traditional big incision has presented with many problem, and at the same time, has given opportunity to make the procedures less invasive. During the past decade, improvement in endoscopic equipments and operative techniques has resulted in development of minimal invasive cardiac operations using small incisions with or without robotics. A number of cardiac procedures are currently performed by minimal invasive approaches and for many surgeons a minimal invasive cardiac surgery has become a standard practice. Herein, we reviewed the minimal invasive cardiac surgery in the aortic valve, mitral valve, tricuspid valve, atrial septal defect, and coronary artery disease.
Aortic Valve ; Coronary Artery Disease ; Heart Septal Defects, Atrial ; Mitral Valve ; Robotics ; Sternotomy ; Thoracic Surgery ; Tricuspid Valve

Extracorporeal Membrane Oxygenation (ECMO) is a variation of cardiopulmonary bypass that temporarily supports tissue oxygenation in patients with life threatening respiratory or cardiac failure. As the ECLS technique becomes safer and simpler following technology advances, and as complications and survival have improved, indication of ECLS has widened. In 2009, a multicentre randomized controlled trial of conventional ventilator support versus extracorporeal life support for severe adult respiratory failure in 180 patients was published (the conventional ventilation or ECMO for severe adult respiratory failure (CESAR) trial). Of patients allocated to ECMO support, 63% survived for six months without disability compared to 47% allocated to conventional ventilation care. This represented the first positive randomized clinical trial on adult ECMO application in acute respiratory distress syndrome patients. In this review, we report on the common terminologies used with ECMO, the practical running mode of ECMO, indications of ECMO application in intensive care unit settings and results of recent clinical trials. In addition, management during ECMO support and common complications of ECMO is outlined. Finally, evolving technologies involved with the progress of ECMO are summarized.
Adult ; Cardiopulmonary Bypass ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Humans ; Intensive Care Units ; Oxygen ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Running ; Ventilation ; Ventilators, Mechanical

BACKGROUND: We evaluate the efficacy of ultra-hydrophilic coated bypass circuits in comparison with uncoated bypass circuits in a porcine cardiopulmonary bypass model. MATERIAL AND METHOD: Normothermic cardiopulmonary bypass was performed in 10 anesthetized pigs via the left atrium and ascending aorta with a centrifugal biopump. Ultra-hydrophilic coated bypass circuits were used in 5 pigs (the study group) and uncoated bypass circuits were used for the control group. Platelet counts and platelet aggregation tests were performed. The thrombin-antithrombin (TAT) complex level and total protein level were evaluated. RESULT: There were no significant changes in the platelet counts and aggregation ability of both groups. The TAT complex levels were not different between the two groups. The total protein level was significantly lower in the control group after cessation of cardiopulmonary bypass. CONCLUSION: The clinical effects of ultra-hydrophilic coating circuits were not remarkable, in terms of reducing inflammatory reaction and protection of platelet function. However, the effect of protection for blood protein adsorption might be acceptable.
Adsorption* ; Aorta ; Blood Platelets* ; Cardiopulmonary Bypass ; Heart Atria ; Platelet Activation* ; Platelet Aggregation ; Platelet Count ; Swine

OBJECTIVE: This study is to report our experience of 40 cases of spinal schwannoma. METHODS: From 1995 to 2006, medical records were retrospectively reviewed in 40 cases of spinal schwannoma. RESULTS:We treated 40 spinal schwannomas in 38 (22 male and 16 female) patients. The mean age was 50.2. Four cases were sited in the cervical spine, 11 cases in the thoracic spine, and 25 cases in the lumbar spine. Two patients showed recurrences. Thirty-eight cases were intradural-extramedullary type and 2 cases were extradural. Two cases (5%) including 1 recurred case had no postoperative motor improvement. Ninety-five percents of patients improved on postoperative motor grade. CONCLUSION: Spinal schwannoma is mostly benign and extramedullary tumor. There were 2 recurred cases (5%) that had history of previous subtotal removal at first operation and had shown worse prognosis compared with the cases without recurrence. To reduce the recurrence of spinal schannoma, total excision of tumor mass should be done.
Humans ; Male ; Medical Records ; Neurilemmoma ; Prognosis ; Recurrence ; Retrospective Studies ; Spine

A 12-year-old female presented with the abnormal findings on the chest PA. The chest CT revealed a retrosternal defect of the diaphragm and a fatty opacity in the pleural cavity, resulting in a diagnosis of Morgagni hernia. It was decided to undergo a laparoscopic surgery. The retrosternal defect of the diaphragm measuring 3.5 cm in diameter was found, through which a portion of the greater omentum and the fatty tissue connected with the falciform ligament were herniated into the pleural cavity. The greater omentum was pushed back into the peritoneal cavity and the fatty tissue connected with falciform ligament was excised. The mediastinal pleura was plicated and the defect of the diaphragm was repaired primarily. Immediately after the operation, the patient developed a right pneumothorax for which a chest tube was inserted. She was discharged at the post-operative third day without any further complications.
Adipose Tissue ; Chest Tubes ; Child ; Diaphragm ; Female ; Hernia ; Hernia, Diaphragmatic ; Humans ; Laparoscopy ; Ligaments ; Omentum ; Peritoneal Cavity ; Pleura ; Pleural Cavity ; Pneumothorax ; Thorax

The single-suture neochorda-folding plasty technique is a modification of existing mitral valve repair techniques. In the authors' experience, its simplicity, reliability, and versatility make it a useful technique for mitral valve repair, especially when a minimally invasive approach is used.
Mitral Valve ; Mitral Valve Insufficiency*

We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.
Aorta ; Female ; Humans ; Marfan Syndrome ; Minimally Invasive Surgical Procedures ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency ; Mitral Valve ; Perfusion ; Sternotomy

no abstract available.

We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.

Purpose: The purpose of this study was to examine the clinical outcomes and efficacy of hip resurfacing arthroplasty (HRA) in patients with osteonecrosis of the femoral head after the failure of porous tantalum rod insertion without rod removal. Materials and Methods: Conversion to hip resurfacing arthroplasty was performed in 10 patients (11 hips) with a mean period of 14.9 months after the primary surgery. The mean follow-up period was 73.7 months. Analysis of pre and postoperative range of motion (ROM), University of California at Los Angeles (UCLA) activity score, modified Harris hip score, and visual analog scale (VAS) pain score was performed. Radiographic analysis of component loosening and osteolysis was performed. Results: The postoperative ROM showed significant improvement (P<0.05), excluding flexion contracture. The modified Harris hip score showed improvement from 65.82 to 96.18, the UCLA score showed improvement from 4.18 to 8.00, and the VAS pain score was reduced from 6.09 to 1.80. All scores showed statistically significant improvement (P<0.05). No component loosening or osteolysis was detected by radiographic analysis. Conclusion Satisfactory results were obtained from conversion hip resurfacing arthroplasty after failure of porous tantalum rod insertion without rod removal. The findings of this study demonstrate the advantages of HRA, including no risk of trochanteric fracture and no bone loss around the tantalum rod. In addition, the remaining porous tantalum rod provided mechanical support, which reduced the potential risk of femoral neck fracture or loosening. This technique can be regarded as a favorable treatment option.