Right anterolateral thoracotomy for repair of atrial septal defect

Grinda, Jean-Michel; Folliguet, Thierry; Dervanian, Patrice; Macé, Loı̈c; Legault, B; Neveux, Jean-Yves

doi:10.1016/0003-4975(96)00182-8

Cited by 72 publications

(52 citation statements)

References 13 publications

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“…3 Atrial septal defects and mitral valve disease being more in females is reported by others also. 5 The results of this study are in contrast to study of Praeger PI et al who operated only functional class IV patients, but is in similarity as for as excellent exposure of left atrium, and difficult aortic cannulation is concerned. 10 Right thoracotomy as an acceptable alternative to median sternotomy is in accordance to other studies.…”

Section: Methodscontrasting

confidence: 83%

“…As reported by others, pericardium was opened anterior to phrenic nerve thymus was separated and the pericardiotomy extended up to left innominate vein superiorly and diaphragm inferiorly. 3,5,6 Pericardial stay sutures were given to isolate the field, to facilitate dissection between aorta and pulmonary artery and to get aorta more anteriorly for easy aortic cannulation, and is as per the recommendations from other centres. 4,[7][8][9] After applying purse string sutures, systematic cannulation, putting patient on bypass, and giving cardioplegia, cardiotomy and intracardiac procedures were done as are performed after a standard median sternotomy.…”

Section: Methodsmentioning

confidence: 99%

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Right thoracotomy approach for open heart surgery

Mir

Ahangar

2015

Int J Res Med Sci

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INTRODUCTIONThough most cardiac operations are performed through median sternotomy because of its versatility and familiarity to surgeons, the fact is sternotomy is not without complications, and the problems of post sternotomy pain, dehiscence, mediastinitis, osteomyelitis and unstable sternum increases morbidity and mortality in these patients. Median sternotomy may also leave a bad scar which patients don't prefer. Alternative to median sternotomy are gaining popularity in cardiac surgery. As an alternative to median sternotomy, the heart may be approached by (i) right parasternal mini-incision, aortic and central venous cannulation, (ii) right submammary mini-incision, femoral arterial cannulation and central venous cannulation, (iii) right submammary mini-incision, femoral arterial cannulation, right atrial cannulation and percutaneous jugular vein cannulation, (iv) parasternal incisions, the (v) hemisternotomy, the (vi) minithoracotomy, (vii) upper half sternotomy and or (viii) lower half sternotomy, (ix) lower small midline skin incision with minimal sternotomy approach, (x) transxiphoid approach without sternotomy. At times horizontal submammary skin incisions are used to split sternum to get the best post-operative results. The concept of alternative approaches for cardiac surgery started only when safety of open heart surgery was ABSTRACT Background: Median sternotomy approach provides excellent exposure of all the chambers of heart for performing open heart surgery, but this approach is the most invasive used for any surgical procedure. Besides an ugly scar, median sternotomy not only increases the morbidity but at times mortality also. To have an acceptable postoperative scar and to avoid the morbidity and mortality associated with median sternotomy, the present study was conducted to find an alternative to median sternotomy in patients with atrial septal defect, mitral and tricuspid valve disease. Methods: Patients were positioned with right side elevated 30-45 degree, and heart was approached by right anterior thoracotomy, through 4th intercostals space. Pericardium was opened anterior to phrenic nerve, and upper end pericardial stay sutures given to get aorta more anterior. Aortic and bicaval cannulation was done and intracardiac procedures were performed as are done after standard median sternotomy. Results: Difficult aortic cannulation and fracture to costochondral junction was the problem observed in some patients. Repair of atrial septal defect was the most common operation performed. Sternotomy, rib resection and peripheral cannulation was not needed in any of these patients. Post-operative period was uneventful in majority. Conclusions: In all patients above 4 years of age, with normal aortic valve, without active lung disease / previous right thoracotomy, having isolated atrial septal defects, mitral and tricuspid valve disease the heart should be approached through right anterior thoracotomy.

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Section: Methodscontrasting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Right thoracotomy approach for open heart surgery

Mir

Ahangar

2015

Int J Res Med Sci

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“…Postoperative results were similar to those reported by other authors [15][16][17][18] . Thus, the minimally invasive approach in children and adolescents is a safe and viable option in relation to conventional techniques.…”

supporting

confidence: 91%

“…In comparison to a full sternotomy, the anterolateral thoractomy appears to be a superior approach particularly in young patients 17 . Chang et al 8 demonstrated that ASD repairs using an anterolateral approach were associated with significantly better clinical results; however, cardiopulmonary bypass durations were considerably longer in the minimally invasive group.…”

Section: Discussionmentioning

confidence: 99%

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

Silveira¹,

Bosco²,

Leite³

et al. 2007

Arq. Bras. Cardiol.

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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.

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“…The incidence of ASD in female is twice that of male, so greater emphasis has been placed on the cosmetic results of the operation. 1 As the increased pulmonary blood flow may lead to development of pulmonary arterial hypertension, closure of large ASD is generally recommended. Various transcatheter closure techniques have been developed, but their use is restricted to selected cases.…”

Section: Introductionmentioning

confidence: 99%

Thoracic approaches in atrial septal defect closure a comparative study

et al. 2017

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INTRODUCTIONAtrial septal defects (ASD) are one of the most common cardiac malformations. Being asymptomatic, diagnosis is not always made in childhood and may be delayed to adolescence or adulthood. The incidence of ASD in female is twice that of male, so greater emphasis has been placed on the cosmetic results of the operation.1 As the increased pulmonary blood flow may lead to development of pulmonary arterial hypertension, closure of large ASD is generally recommended. Various transcatheter closure techniques have been developed, but their use is restricted to selected cases. Thus, surgical closure remains the treatment of choice. It is usually performed using cardiopulmonary bypass (CPB) by a sternal approach. The cosmetic and psychological implications of a median sternotomy must now be considered as a possible factor for morbidity. Due to success of percutaneous closure technique, surgeons must be able to propose an operation that can provide a cosmetically satisfying result while maintaining optimal surgical security. Currently focus is on the cosmetic results of surgical interventions. Limited right anterolateral thoracotomy is an alternative approach with regard to cosmetic aspects and good postoperative outcome. [2][3][4]7,9,11 The right anterolateral thoracotomy is ABSTRACT Background: Atrial septal defects (ASD) are one of the most common cardiac malformations. Being asymptomatic, diagnosis is not always made in childhood and may be delayed to adolescence or adulthood. The incidence of ASD in female is twice that of male, so greater emphasis has been placed on the cosmetic results of the operation. Conclusions: Surgical treatment of osteum secondum ASD using right anterolateral thoracotomy approach has low operative risk better cosmetic results and patient satisfaction.

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Right anterolateral thoracotomy for repair of atrial septal defect

Cited by 72 publications

References 13 publications

Right thoracotomy approach for open heart surgery

Right thoracotomy approach for open heart surgery

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

Thoracic approaches in atrial septal defect closure a comparative study

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