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At least 415 records · Page 23Linked to original sources
PubMed1991

Rib fractures complicating median sternotomy.

The postoperative chest radiographs of 100 consecutive patients undergoing median sternotomy were reviewed for the presence of acute rib fractures. The majority of patients underwent coronary artery bypass grafting. Thirteen patients sustained 15 fractures. Eleven of these fractures were of the left first rib and 7 of the 15 fractures occurred at the costotransverse articulation. The fractures tended to be subtle on the postoperative portable chest radiographs and were initially overlooked in 4 patients. Heavier patients and those with larger body surface areas were more susceptible to the development of fractures. There was no statistical correlation to total operating time, bypass time, or global ischemic time.

Aged↗
PubMed1992

Breast development and areola sensitivity after submammary skin incision for median sternotomy.

Vertical incision for median sternotomy may result in unsightly scars. Therefore we have used a horizontal approach in women since the early 1980s. Of 36 women, 27 came for a follow-up examination. A tendency toward scar hypertrophy was found medially in 7 women. Four breast-fed their child after operation. Reduced areola sensitivity occurred in only 9 women. Horizontal submammary skin incision resulted in cosmetically acceptable scar formation and did not harm breast development and lactation.

Adolescent↗
PubMed1992

Partial median sternotomy for repair of heart defects: a cosmetic approach.

A modified median sternotomy incision that results in a cosmetically appealing scar is described. It includes the use of a low-lying short skin incision and partial transection of the sternum. The outcome in 182 infants and children indicates that this approach is safe, provides adequate exposure, and has excellent cosmetic results.

Adolescent↗
PubMed1992

Limited vertical skin incision for median sternotomy.

The cosmetic deformity of the vertical skin incision for median sternotomy was decreased by using a mechanical traction system to increase exposure at the superior margin of a shorter wound. The limited vertical skin incision did not impede technical surgical maneuvers and produced a scar that was more acceptable than submammary incision or right anterior thoracotomy. The limited skin incision is especially useful in young women with congenital heart disease.

Adolescent↗
PubMed1992

Bilateral anterior thoracotomy for automatic implantable cardioverter defibrillator placement in patients with previous sternotomy.

Bilateral anterior thoracotomy, extrapericardial patches, and endocardial sensing lead placement have been used in 40 patients with previous sternotomy. The mean defibrillation threshold was 15 J, and in all patients the defibrillation threshold was less than 20 J. The surgical procedure is simplified with less risk by avoiding dissection of previously operated regions. Serious pulmonary complications have been avoided by adequate pain control with epidural analgesia and early mobilization. This technique has successfully been used in patients with underlying chronic obstructive pulmonary disease and amiodarone-induced pulmonary fibrosis. All patients have been extubated by the first postoperative day.

Electric Countershock↗
PubMed1992

Reactive hyperemia in the nonused internal mammary artery after median sternotomy.

Doppler spectrum analysis was performed in the nonused internal mammary artery in a group of patients who underwent myocardial revascularization using the contralateral internal mammary artery and in both internal mammary arteries in a group of patients who underwent median sternotomy for cardiac surgical procedures in which the internal mammary artery was not used. In all nonused internal mammary arteries the preoperatively triphasic systolic flow pattern had postoperatively converted into a unidirectional systolic flow pattern with a large diastolic flow component, characterized by a significant increase in the diastolic flow parameters and a significant decrease in the resistance and pulsatility indices. This effect had almost subsided at 6 months postoperatively. This study indicates that the reactive hyperemia observed in the nonused internal mammary artery in the early postoperative period is mainly caused by the temporarily increased metabolic demand of the anterior thoracic wall and mediastinum, rather than by the metabolic demand of the anterior diaphragm and the contralateral rectus abdominis muscle after deprivation of their main nutritional vessel.

Adolescent↗
PubMed1992

Prolonged open sternotomy and delayed sternal closure after cardiac operations.

Maintenance of an open sternotomy (OS) after a complicated cardiac operation is an adjunct in the treatment of the severely impaired heart. We hypothesized that predictors of the timing, morbidity, and prognosis of delayed sternal closure (DSC) could be determined by intensive case review. Prolonged OS was used in 107 of 6,030 adult open heart patients (1.8%) between 1987 and 1991. Indications for OS were hemodynamic instability (40), myocardial edema (18), intractable bleeding (23), relentless arrhythmias (9), and ventricular assist devices (17). Delayed sternal closure was carried out in 75 of 107 patients at a mean of 3.4 +/- 0.3 days after OS. Fifty of these 75 (67%) survived and were discharged an average of 43 +/- 6 days after closure. Fifty-seven patients died: 32 before DSC at 3.7 +/- 0.8 days after OS and 25 after DSC at 27 +/- 4 days after OS. Baseline cardiac index (1.7 +/- 0.1 L.min-1.m-2) improved an average of 1.0 +/- 0.1 L.min-1.m-2 after OS (p less than or equal to 0.001) and remained stable through DSC (2.5 +/- 0.3 L.min-1.m-2) and late (9 +/- 0.7 days) follow-up (2.8 +/- 0.1 L.min-1.m-2). Delayed sternal closure in patients without ventricular assist devices was significantly more likely to be successful (45/63 versus 9/27; p less than 0.002) when carried out after the onset of a negative daily fluid balance. Sternal infection occurred in 4 of 75 (5%) patients after DSC and was associated with bleeding as an indication for OS (3/15 versus 1/60; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Simple approach for extrapericardial placement of defibrillator patches via median sternotomy.

The intrapericardial placement of implantable cardioverter defibrillator patches has been associated with a variety of complications due to the patch-epicardial interface. Extrapericardial placement of defibrillator patches minimizes these problems. We describe a simple and reproducible technique to achieve this goal whenever a median sternotomy approach is used.

Defibrillators, Implantable↗
PubMed1996

Hemopump 31, the sternotomy Hemopump: clinical experience.

BACKGROUND: Postcardiotomy cardiogenic shock remains a challenging situation. Many devices can be used although none of them directly unload the left ventricle except for the Hemopump. We report our clinical experience with the Hemopump 31 or sternotomy Hemopump. METHODS: From 1992 to 1994, 15 patients received a Hemopump 31. All suffered postcardiotomy cardiogenic shock either after coronary artery bypass grafting (n = 14) or after heart transplantation (n = 1). Patients enrolled had refractory heart failure despite the use of optimal inotropic support. Three groups can be identified: group 1 (n = 2 patients), double Hemopump right and left; group 2 (n = 4), patients with delayed insertion after intraaortic balloon pump failure; and group 3 (n = 9 patients), immediate insertion. The average support of duration for the survivors was 5 days. RESULTS: No mechanical failure or device-related complication was noticed. There were striking differences between groups 1 and 2 as opposed to group 3, as only 1 patient survived in group 2 and none in group 1, as opposed to 5 patients in group 3. Overall survival is 40%. All patients were discharged from the hospital. CONCLUSIONS: Factors showing adverse effect are biventricular failure, vasoconstrictor requirement, and delayed insertion. We believe the Hemopump is a more efficient device than the intraaortic balloon pump, and that early use after onset of heart failure achieves better results.

Adult↗
PubMed1996

Sensitivity to sternotomy wires may cause postoperative pruritus.

An eczematous eruption developed on the anterior chest of a 58-year-old woman with known nickel sensitivity after the insertion of nickel-containing sternotomy wires. Her wound was revised with removal of the wires to give immediate and sustained relief from the itch. The electron microscopy and parasternal biopsy histology demonstrating a sarcoidal reaction are discussed.

Dermatitis, Allergic Contact↗
PubMed1996

Mini-sternotomy for coronary artery bypass grafting.

This communication details the approach to the left anterior descending artery, right coronary artery, or both via a single limited incision of the chest. The mini-sternotomy incision is 10 to 12 cm long. The distal anastomosis can be accomplished, with a beating heart, through this small incision, with or without cardiopulmonary bypass.

Cardiopulmonary Bypass↗
PubMed1991

Tracheoaortopexy via midline sternotomy in tracheomalacia.

Symptomatic tracheomalacia associated with congenital tracheoesophageal fistula requires active treatment. When symptoms are severe, consideration should be given for surgical correction. Aortopexy via a lateral thoracotomy and tracheopexy via an anterior cervical approach have been described. We present two patients with extensive tracheomalacia who benefited from combined tracheoaortopexy via a midline sternotomy approach.

Cartilage Diseases↗
PubMed1986

Sternotomy and portal triad division for cadaver donor nephrectomy.

Modification of the en bloc resection of kidneys for cadaveric kidney transplant patient is described. A median sternotomy and division of the portal triad provide excellent exposure of the upper aorta above the celiac axis. This approach has been used in 40 cadaveric donors with no complications.

Aorta, Abdominal↗
PubMed1993

Brachial plexus injury after median sternotomy.

Serious brachial plexus injury after median sternotomy is uncommon. However, affected patients experience considerable morbidity and their return to regular employment is often delayed. The pathogenesis of the injury is multifactorial. Wide sternal retraction is the major etiologic factor. Management is primarily conservative and should be guided by a team experienced in upper limb and hand surgery. Our experience at a major referral center during a 3-year period is described.

Adult↗
PubMedDate not supplied

Characterization of Mycobacterium fortuitum isolates from sternotomy wounds by antimicrobial susceptibilities, plasmid profiles, and ribosomal ribonucleic acid gene restriction patterns.

An outbreak of sternotomy infections due to Mycobacterium fortuitum in patients who had received cardiovascular surgery occurred in a cardiothoracic hospital in Hong Kong, and 21 such isolates from different patients had antimicrobial susceptibility studies against 14 drugs in vitro. These isolates were also studied for plasmid profiles and ribosomal ribonucleic acid gene restriction patterns. The latter method proved valuable in categorization of these isolates into two groups (comprising of nine and seven isolates, respectively) and five other sporadic strains. When the plasmid profiles and ribotyping are matched against the clinical and epidemiologic data, multisource contamination is suspected to be responsible for the outbreak. The organisms were probably derived from the environment rather than contaminated surgical equipments and materials.

Adult↗
PubMed1990

Coarctation of the aorta in complex congenital heart disease: simultaneous repair via sternotomy.

Coarctation of the aorta (CoA) is often associated with complex congenital heart disease. Patients with such a combination may not benefit from coarctectomy alone. Eight children who presented with complex malformations of the heart underwent simultaneous repair of CoA and intracardiac surgery via sternotomy. After extensive mobilization of the aortic arch, cardiopulmonary bypass was established. During the cooling phase for deep hypothermic circulatory arrest (six cases), a persistent temperature gradient between the upper and lower half of the body confirmed the significance of CoA. One child was operated upon in deep hypothermia with low flow and one underwent valve repair on cardiopulmonary bypass. Mobilization of the descending aorta enabled CoA resection and end-to-end anastomosis with a running absorbable suture. The average descending aortic cross-clamping time was 15 min. By this time, the patient had been cooled sufficiently for the intracardiac procedure. There were two operative deaths not related to coarctectomy. The remaining children showed no arm-to-leg pressure gradient. Five were discharged from hospital and one patient died late from septicaemia. In our hands, this technique has served to accomplish simultaneous relief of CoA and repair of the intracardiac lesion thus sparing critically ill infants the hazards of repeated procedures.

Aorta, Thoracic↗