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[Correction of cardiac defects through a right minithoracotomy in children]
1Department of Cardiac Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037.
Insights
Right minithoracotomy offers a safe and effective surgical approach for congenital heart defect correction. This minimally invasive technique provides superior cosmetic outcomes and reduced patient injury compared to traditional methods.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Context:
- Congenital heart defects require surgical correction, traditionally performed via median sternotomy.
- Minimally invasive approaches are increasingly explored to reduce surgical trauma and improve outcomes.
- Right minithoracotomy presents a viable alternative for specific congenital cardiac repairs.
Purpose:
- To evaluate the safety and efficacy of right minithoracotomy for correcting congenital cardiac defects.
- To compare the outcomes of right minithoracotomy with conventional surgical techniques.
- To assess the benefits of right minithoracotomy regarding patient recovery and cosmetic results.
Summary:
- 319 pediatric patients underwent congenital heart defect repair using right lateral thoracotomy.
- Procedures included atrial septal defect, ventricular septal defect, and Tetralogy of Fallot correction.
- No operative mortality or severe complications were observed, with favorable recovery times.
Impact:
- Right minithoracotomy demonstrates a safe and effective alternative to median sternotomy for congenital cardiac defect correction.
- This approach minimizes injury, preserves thoracic integrity, and prevents deformities like pigeon breast.
- Superior cosmetic results are achieved compared to sternotomy or bilateral submammary incisions.
Objective:
To review the experience of correction of congenital cardiac defects through a right minithoracotomy.
Method:
319 patients underwent correction of congenital heart malformations through right lateral thoracotomy under cardiopulmonary bypass. The average age was 3.44 +/- 1.59 years (range, 5 months-8 years). The average body weight was 13.66 - 3.98 kg (range, 6 - 26 kg). Cardiac defects repaired included atrial septal defect in 87 patients (1 patient associated with left superior vena cava (LSVC), 6 pulmonary stenosis, 5 partial anomalous pulmonary venous connection), ventricular septal defect in 200 (7 patients with coexisting patent ductus arteriosus, 7 mitral insufficiency, 3 LSVC, 11 right ventricular outflow tract obstruction), Fallot's Tetralogy in 19 (3 patients associated with LSVC, 1 single coronary malformation), partial endocardial cushion defect in 2 and other defects in 11. The mean cardiopulmonary bypass time was 56.07 +/- 24.90 min (range, 20 - 176 min) and the mean aortic crossclamping time was 32.97 +/- 20.38 min (range, 6 - 140 min). The average mechanical ventilation time after operation was 18.75 +/- 24.57 hr (range, 2 - 140.72 hr), and the mean postoperative hospital stay was 7.08 +/- 0.69 days (range, 7 - 17 days).
Result:
No operative mortality and severe postoperative complications were noted.
Conclusion:
The right lateral thoracotomy is a safe and effective alternative to a median sternotomy for correction of cardiac defects. Advantages of this approach include less injury, maintaining the continuity and the integrity of the bony thorax, and preventing postoperative pigeon breast. The cosmetic result is superior to that of median sternotomy or bilateral submammary incision.