Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy

To investigate the feasibility and cosmetic results of a right subaxillary thoracotomy for closure of doubly committed subarterial ventricular septal defects.

From October 2009 to September 2015, 78 patients [50 boys, 28 girls, mean age 4.7 ± 2.9 years (range, 0.5-15 years) and mean body weight 16.3 ± 9.6 kg (range, 7-42 kg)] with doubly committed subarterial ventricular septal defects were treated with minimally invasive surgical closure through a right subaxillary thoracotomy. All procedures were performed through an oblique 5- to 8-cm subaxillary mini-incision and the fourth intercostal space. The defect was approached through the main pulmonary artery or the right ventricular outflow tract. The defect was closed with a piece of Dacron patch or directly with one to two pledgetted polypropylene sutures. Additional procedures involved closure of atrial septal defects, closure of patent foramen ovale, mitral annuloplasty, tricuspid annuloplasty and relief of right ventricular outflow tract obstruction.

The median cardiopulmonary bypass and aortic cross-clamp times were 51 ± 26.5 (33-78) and 27 ± 13.6 (15-46) min, respectively. The incision length was 6.7 ± 1.5 cm (range, 5.0-8.0 cm). The follow-up period was 37 ± 27.5 months (range, 6-72 months). The cardiac defect was repaired with a trivial to mild residual defect in 3 patients (2 patients with a small residual shunt and 1 with mild mitral regurgitation). No chest deformity or asymmetrical development of the breast was found.

A right subaxillary thoracotomy, providing a feasible alternative to median sternotomy, can be performed with favourable cosmetic and satisfactory clinical results for closure of doubly committed subarterial ventricular septal defects.