Abstract
Background
Though the use of median stermotomy has been fairly standardized for the approach to the heart and great vessels, since the advent of cosmetically appealing incisions, thoracotomy has come to be a justifiable alternative incision. This paper presents our experience with this approach and the advantages over the conventional approach as well as over other incisions for the correction of intra-cardiac anomalies.
Methods
93 patients underwent open cardiac procedures using the posterior thoracotomy approach since June 1997 to December 2000. There were 69 patients with ostium secundum atrial septal defects and 12 patients with sinus venous defects. Other anomalies included perimembranous ventricular septal defects in 3 patients, partial atrioventricular septal defects in 3 patients and transitional atrioventricular septal defects in 2 patients. Besides these, one patient each underwent atrial septectomy with right modified Blaloc—Taussing shunt and correction of hemianomalous pulmonary venous connection with intact atrial septum using this approach. The median age of the patients was 8 years with a range of 10 months to 41 years. 10 patients were males.
Results
The median operation time (skin to skin) was 236 minutes. Median bypass times and aortic cross clamp times were 63 minutes and 31.5 minutes respectively. The median ICU stay was 25.2 hours. There were no significant immediate post operative complications requiring intervention in any patient. The mean chest drainage was 80 ml per 24 hours. One patient had a superficial wound dehiscence which healed with daily dressings One patient had atelectasis of the right upper lobe which recovered with chest physiotherapy. All patients are on regular follow up to assess the status of their scars. One patients developed a mass on the right atrial free wall following closure of atrial septal defect one year earlier and the underwent reoperation for removal of the mass. Patients on follow up were interrogated and all were satisfied with the cosmesis of their scars. None of the patients had any physical disability due to their scars.
Conclusions
The limited posterior thoracotomy incision offers a cosmetically attractive approach to the heart in selected patients. The approach is easy and the techniques reproducible. The technique carries with it no additional risk and has the advantage of not interfering with future development of the breast in young pre pubertal girls.
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References
Barbero-Marcial M, Tanamati C, Jatene MB, Atik E, Jatene AD. Transxiphoid approach without median sternotomy for repair of atrial septal defects. Ann Thorac Surg 1998; 65: 771–74.
Gerbode F, Bainbridge MV, Melrose DG. Median sternotomy for open cardiac surgery during total heart-lung bypass. Arch Surg 1958; 76: 821–24.
Julian OC, Lopez-Beliom M, Dye WS, Javid H, Grove WV. The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery. Surgery 1957; 42: 753–61.
Cooley DA. Techniques in cardiac surgery. 2nd ed. Philadelphia: WB Saunders, 1984.
Dietl CA, Torres AR, Favalero RG. Right submammarian thoracotomy in female patients with atrial septal defects and anomalous pulmonary venous connection: comparison between the transpectoral and subpectoral approaches. J Thorac Cardiovasc Surg 1992; 104: 723–27.
Cherian KM, Pannu HS, Madhusankar N, et al. Thoracotomy approach for congenital and acquired heart defects: its possible applications in the current eral. J Card Surg 1996; 11: 37–45.
Black MD, Freedom RM. Minimally invasive repair of atrial septal defects. Ann Thorac Surg 1998; 65: 765–67.
Cherup LL, Siewers RD, Futrell JW. Breast and pectoral muscle maldevelopment after anteerolateral and posterolateral thoracotomies in children. Ann Thorac Surg 1986; 41: 492–97.
Levinson MM, Dewhurst T, Han MT, Fooks G, Fonger J. Cosmetic minimally invasive surgical closure of a patient foramen ovale. Report and surgical technique. In: The heart surgery forum. 1996; 2451
Tatebe S, Eguchi S, Miyamura H et al. Limited vertical skin incisionn for median sternotomy. Ann Thorac Surg 1992; 54: 787–88.
Komai H, Naito Y, Fujiwara K et al. Lower skin incision and minimal sternotomy—a more cosmetic challenge for pediatric cardiac surgery. Cardiol Young 1996; 6: 76–79.
Wilson WR Jr, Ilbawi MN, DeLeon SY, Piccione W, Jr, Tubeszewski K, Cutilleba AR. Partial median sternotomy for repair of heart disease: a cosmetic approach. Ann Thorac Surg 1992; 54: 892–93.
Uva MS, Roussin R, Petit J, Lacour-Gayet F, Serraf A, Planche C. Thoracotomie posterio-droite pour le traitement des lesions simples et isolees du coeur. Presse Med 1995; 24: 402–04.
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Varghese, R., Shivaprakasha, K., Mohanty, S. et al. Limited posterior thoracotomy for the correction of intra cardiac anomalies–current perspectives. Indian J Thorac Cardiovasc Surg 17, 82–85 (2001). https://doi.org/10.1007/s12055-001-0012-2
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DOI: https://doi.org/10.1007/s12055-001-0012-2