Right Lateral Minithoracotomy for Closure of Atrial and Ventricular Septal Defect in Children

Ersin Erek ¹, Dilek Suzan ¹, Selim Aydin ¹, Bahar Temur ¹, Okan Yildiz ², Baris Kirat ¹, Ibrahim H. Demir ¹, Ender Odemis ¹

¹ Acibadem Mehmet Ali Aydinlar University , Istanbul, Turkey; ² Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey;

Date, time and location: 2018.05.25 13:30, Press Hall, 2F

Abstract

Introduction: After corrective operations with excellent long-term results, such as ASD and VSD closure,the sternotomy scar may cause discomfort and physchosocial problems. Right lateral minithoracotomy (RLM) approach by avoiding the breast growth region, is an alternative option with better aesthetic results. Here we report our results with this technique.

Methods: Between December 2010 and December 2017, Right lateral thoracotomy approach was performed in 52 children. Their ages were between 6 months to 17 years (median 4,5 years). The smallest body weight was 5000 gr. Eighteen of them were male and 34 female (65%). Their pathologies were ASD (n=32); VSD (n=9); ASD+partial abnormal pulmonary venous connection (n=5); partial atrioventricular septal defect (n=5) and VSD+Pulmonary stenosis (n=1). The incisions were made between anterior to posterior axillary line on sixth intercostal space (ICS). Chest cavity was entered via 4th ICS. All cannulations were performed through the same incision. Long shafted “Heartport” instruments were used.

Results: There was no mortality. No revision for bleeding required. Rate of blood transfusion was very low (5.7%). One patient had transient A-V Block. One patient had chylothorax. Only 1 patient had small residual VSD during follow-up. Thoracic incisions were between 5-7 cm in lenght. No surgical site infection was observed.

Conclusion: Right lateral minithoracotomy may be used for wide range of operations even in small infants. It’ s safe and effective with more satisfactory aesthetic results.