Open-heart surgery in 48 patients via a small right anterolateral thoracotomy

To limit the trauma to the chest and to achieve a pleasing cosmetic result, we used 2 types of right anterolateral thoracotomy in 48 patients who required open-heart surgery: 1 was a curved incision along the lower edge of the right breast in women with developed breasts; the other was a slanted incision for men and children. These surgical procedures took place between July 1996 and November 1997. Intraoperatively, a right atriotomy was used to repair 11 atrial septal defects and 11 ventricular septal defects, 2 combined atrial and ventricular septal defects, 1 case of a single atrium, and 1 partial atrioventricular canal. A right ventricular outflow tract incision was used to repair 7 ventricular septal defects and 7 ruptured aortic sinus aneurysm. A combination of a right atriotomy and right ventricular outflow tract incision was used for 2 repairs of combined atrial and ventricular septal defects, 3 radical corrections of tetralogy of Fallot, and 2 radical corrections of trilogy of Fallot. A combined right and interatrial septal incision was used for 6 mitral valve replacements and 1 mitral valvuloplasty. Smooth bypass cannulation and satisfactory intracardiac exposure were achieved with the right anterolateral thoracotomy. There was no complication or mortality directly related to the incision. We believe that the right anterolateral thoracotomy is safer and more effective than the median sternotomy for many common congenital and acquired heart diseases. The thoracotomy causes less trauma and results in a cosmetic appearance that is more acceptable to the patient.