Right Anterolateral Thoracotomy in the Repair of Atrial Septal Defect: Effect on Breast Development

Işık, Onur; Ayık, Mehmet Fatih; Akyüz, Muhammet; Daylan, Ahmet; Atay, Yüksel

doi:10.1111/jocs.12593

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…The authors recommended abandoning right anterolateral thoracotomy in prepubescent female patients, although subjective satisfaction with the cosmetic results was high [ 15 ]. Isik and his colleagues also concluded that ALMT was associated with the potential to affect unilateral breast development [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Anterolateral minithoracotomy versus median sternotomy for the surgical treatment of atrial septal defects: a meta-analysis and systematic review

Lei

Liu

Xie

et al. 2021

J Cardiothorac Surg

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Background To compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs). Methods The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for comparative studies focusing on surgical repair of ASDs via ALMT or MS published up to the end of April 27, 2020. We used random-effect or fixed-effect models to obtain pooled estimates. Results A total of 7 publications, including 665 patients (ALMT 296 and MS 369), were included. Age (WMD: 1.80 years, 95% CI 0.31–3.29), weight (WMD: − 0.91 kg, 95% CI − 5.57 to 3.75), sex distribution (OR: 1.00, 95% CI 0.74–1.35) and surgical type (patch or direct closure) (OR: 1.00, 95% CI 0.67–1.49) were comparable in the ALMT group and MS group. No significant differences in the success rate (OR 0.23; 95% CI 0.05–1.07) or severe complication rate (OR 1.46; 95% CI 0.41–5.22) were found between the ALMT group and the MS group. In addition, the differences in the cardiopulmonary bypass (CPB) time (WMD 6.33; 95% CI − 1.92 to 14.58 min, p = 0.13) and the operation time (WMD 5.23; 95% CI − 12.49 to 22.96 min, p = 0.56) between the ALMT group and the MS group were not statistically significant. However, the ALMT group had a significantly longer aortic cross-clamp time (2.37 min more, 95% CI 1.07–3.67 min, p = 0.0003). The intubation time was 1.82 h shorter (95% CI − 3.10 to − 0.55 h; p = 0.005), the intensive care unit (ICU) stay was 0.24 days shorter (95% CI − 0.44 to − 0.04 days; p = 0.02), and the postoperative hospital stay was 2.45 days shorter (95% CI − 3.01 to − 1.88 days; p < 0.00001) in the ALMT group than in the MS group. Furthermore, the incision length was significantly shortened by 8.97 cm in the ALMT group compared with the MS group (95% CI − 9.36 to − 8.58 cm; p < 0.00001). Conclusions In the surgical treatment of ASD, ALMT and MS are equally safe and effective in terms of success rates and severe complication rates. The surgical procedures are equally difficult, but ALMT is associated with a faster functional recovery and better cosmetic results. Compared to MS, ALMT is the better choice for select ASD patients.

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Section: Discussionmentioning

confidence: 99%

Anterolateral minithoracotomy versus median sternotomy for the surgical treatment of atrial septal defects: a meta-analysis and systematic review

Lei

Liu

Xie

et al. 2021

J Cardiothorac Surg

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“…As a balancing argument, they reported that 76% of patients in the thoracotomy group perceived their cosmetic results as excellent in contrast to 39% of patients in standard full median sternotomy group. Similarly, Isik and colleagues 33 reported breast asymmetry occurrence in 60% and mild sensory deficit in the mammary area in 16% of women who underwent ASD closure in prepubertal age via anterolateral thoracotomy. Clearly, the anterolateral thoracotomy approach should be used cautiously, if at all, in prepubertal female patients.…”

Section: Right Thoracotomymentioning

confidence: 85%

“…10 While similar access can be achieved via a right anterolateral thoracotomy, 16,21,22 some cosmetically undesirable outcomes have been reported. 30,33 Impaired breast development is of concern, as it is challenging to determine the appropriate length and position of the incision in a child with respect to the immature breast tissue. According to Bleiziffer and colleagues 30 right breast asymmetry was reported in 61% of female patients who underwent ASD closure via right anterolateral thoracotomy before onset of puberty compared with no such events in standard full median sternotomy group.…”

Section: Right Thoracotomymentioning

confidence: 99%

Minimally invasive approaches to atrial septal defect closure

et al. 2022

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“…4 Right mini-thoracotomy surgical approach provides an optimal exposure of both RA and LA, facilitating the search for abnormal venous drainage, especially if the skin is incised a few centimeters more anterior than is usually done for a right mini-thoracotomy through the fourth intercostal space across the anterior axillary line. 5 In this particular case, it was very easy to identify all anatomical structures, and the correction was accomplished without complications. The femoro-femoral cardiopulmonary bypass was optimal because it left the IVC free from a venous cannula, which could interfere with the patch suture.…”

Section: Commentmentioning

confidence: 88%

Minimally Invasive Approach to Correct Anomalous Inferior Vena Cava Connection to the Left Atrium

Napoleone

Marini

Baronetto

et al. 2017

World J Pediatr Congenit Heart Surg

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Anomalous drainage of the inferior vena cava into the left atrium is a rare congenital condition. A 20-year-old girl was referred for recurrent transient ischemic attacks. Transthoracic echocardiography revealed a large ostium secundum atrial septal defect, and computed tomography showed anomalous drainage of the inferior vena cava into the left atrium. Through a right mini-thoracotomy, the opening of the inferior vena cava into the atrium was identified under the inferior edge of the interatrial septum, draining into the left atrium, and redirected to the right atrium, using a pericardial patch to reconstruct the atrial septum. Postoperative course was uneventful. Right mini-thoracotomy approach was effective in correcting the anomalous drainage of the inferior vena cava into the left atrium.

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Right Anterolateral Thoracotomy in the Repair of Atrial Septal Defect: Effect on Breast Development

Abstract: Although it is safe, the RALT is associated with the potential to effect unilateral breast development.

Cited by 9 publications

References 13 publications

Anterolateral minithoracotomy versus median sternotomy for the surgical treatment of atrial septal defects: a meta-analysis and systematic review

Anterolateral minithoracotomy versus median sternotomy for the surgical treatment of atrial septal defects: a meta-analysis and systematic review

Minimally invasive approaches to atrial septal defect closure

Minimally Invasive Approach to Correct Anomalous Inferior Vena Cava Connection to the Left Atrium

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