Correção de defeitos cardíacos congênitos simples em crianças e adolescentes por meio de minitoracotomias

Abstract

SummaryObjective: To evaluate the repair of congenital heart defects through minithoracotomies.Methods: Between January 1998 and March 2005, 98 patients underwent minithoracotomies for simple congenital heart defect repairs at our institution. All patients were female between the ages of 14 months and 16 years (mean 4.6) with weights ranging from 8 to 58 Kg (mean 20). Diagnoses included 78 cases of atrial septal defects (ASD) (six with associated partial anomalous pulmonary venous drainage and four with pulmonary valve stenosis) and 20 cases of perimembranous ventricular septal defects (PVSD). All diagnoses were confirmed with an echocardiogram; therefore, cardiac catheterization was not required. A right submammary minithoracotomy was performed on 10 patients and a minithoracotomy with a partial median sternotomy was performed on 88 patients.Results: All defects were corrected successfully with satisfactory exposure. Cardiopulmonary bypass times ranged from 8 to 30 min (mean 10) and aortic clamping times ranged from 5 to 22 min (mean 12). All patients were extubated in the operating room and hospital stays ranged from 3 to 7 days (mean 5). There were no deaths during the operation or severe postoperative complications. No residual shunts were observed.Conclusions: Our study demonstrated that the minithoracotomy is a safe effective and technically viable alternative to a median sternotomy to correct selected simple congenital heart defects. The advantages of this approach include less trauma, partial or complete preservation of sternum continuity and integrity, and elimination of postoperative deformities such as pectus carinatum. The cosmetic outcome was superior to a median sternotomy.

Perventricular device closure of a doubly committed juxtaarterial ventricular septal defect through a left parasternal approach: midterm follow-up results

“…A pericardial drainage tube is needed in each case. Postoperative pain and the pectus carinatum deformity are common after this procedure [ 7 , 16 ]. The parasternal approach is performed through an intercostal access port without entering into the pleural space.…”

Ministernotomy for correction of ventricular septal defect

“…Over the past two decades, this type of surgery has been advocated for both adults and children in an effort to reduce costs related to hospital stay, and to improve the cosmetic results. Particularly in the pediatric population, awareness should be paid to the cosmetic and psychological consequences of a conventional full sternotomy, as this could have an important role in postoperative recovery [ 3 ]. By using minimal skin incisions and a ministernotomy, surgical trauma can be reduced.…”

Associação entre as complicações pulmonares e fatores predisponentes em cirurgias cardiopediátricas

“…A esternotomia mediana e a minitoracotomia são os tipos de incisões cirúrgicas mais utilizadas, sendo que a escolha da técnica adequada para cada tipo de procedimento cirúrgico é um dos fatores mais importantes, pois há estudos evidenciando que a introdução dessas técnicas minimamente invasivas é capaz de reduzir o trauma operatório. Contudo ainda é questionável a escolha da técnica com relação à dor pós-operatória, sangramento, e à melhora da função pulmonar 5 .…”