Children with congenital heart defects are mainly referred during the neonatal period and infancy with impairment in gaining weight. Ventricular septal defect is the most frequent heart defect.

The periareolar access has been the preferred technique used at our institution for minimally invasive cardiac surgery since 2006. The surgical approach consists of video-assisted minithoracotomy in the 4th right intercostal space, through a periareolar incision. Initially, the technique was restricted to minimally invasive mitral valve surgeries but, due to its feasibility and safety, was soon incorporated as an ideal access for other cardiac pathologies such as tricuspid valve disease, atrial septal defect, atrial fibrillation, and pacemaker leads endocarditis. The technique was performed in 214 patients, and it is associated with excellent aesthetic and functional results, with low morbimortality and no reoperations at long-term follow-up. Here, we describe and support the use of periareolar access as a routine surgical technique for correction of several cardiac pathologies, especially in women.

POFFO, R ET AL -Minimally invasive video-assisted atrial septal defect correction and myocardial revascularization Rev Bras Cir Cardiovasc 2009; 24(4): 586-589 thread (Monocryl®). The other openings were closed using simple 5-0 nylon sutures. The dressings were prepared using micropore®.

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Objective:To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery.Methods:From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy.Results:The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days.Conclusion:Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.

Descriptors: Heart septal defects, atrial. Surgical procedures, minimally invasive/methods. Robotics.Descritores: Comunicação interatrial. Procedimentos cirúrgicos minimamente invasivos/métodos. Robótica. CHARACTERIZATION OF PATIENTThe characteristics of the patient are: female, 24 years old, 55 kg. She came to our department with complaints of fatigue and palpitations. She denied any associated disease or medication use. On physical examination, the patient was eutrophic, eupneic at rest, without edema. No alterations of pulmonary auscultation and cardiac auscultation revealed a sinus rhythm, with pulmonary systolic murmur with fixed splitting of 2nd heart sound. Resting blood pressure (BP) was: 100/70 millimeters of mercury (mmHg).The chest radiograph showed normal heart size and increased pulmonary vasculature. Echocardiography revealed a normal left atrial dimension (LA) of 2.9 centimeters (cm) and left ventricular (LV) diameter within normality (LV Systolic Diameter: 2.5 cm -LV Diastolic Diameter: 4.2 cm ) and normal myocardial thickness. The other cavities were also normal. The presence of interatrial comunication (IAC) secundum ostium type showed the Doppler that the shunt with unidirectional flow of LA to the right. The ejection fraction was estimated at 72% (Simpson). The pulmonary artery pressure was estimated at 40 mmHg and increased pulmonary blood flow: 1.5 cm /second (cm/s).The electrocardiogram showed sinus rhythm with right bundle branch block.After discussing the clinical case, the surgery to repair the IAC was indicated. In a conversation with the patient after the explanation of the techniques type available to the IAC and also signed informed consent, she chose the robot-assisted minimally invasive approach [1].Surgical correction consisted of atrial septal defect with a bovine pericardial patch. The duration of extracorporeal circulation (EC) was 63 minutes (min) and aortic clamping, 38 min.The patient was extubated in the operating room; the postoperative bleeding was 340 milliliters (ml), length of ICU stay of 14 hours, had a great postoperative evolution and was discharged on the 2nd day after surgery. On the discharge day, the echocardiogram showed a normal ventricular function and an intact atrial septum, with well positioned patch without residual shunt.

Background: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci ® robotic system was performed in LatinAmerica. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil.Methods: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy.Results: The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term.Conclusions: Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra-and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.

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