Right postero-lateral thoractomy for atrial septal defect closure a comparitive analysis with median sternotomy

Abstract

Introduction: Approach to repair of Ostium Secundum atrial defect has undergone modifications in the last decade, with right thoracotomy, being one common approach pursued by.Methods: Right Posterolateral thoracotomy (RPLT) was offered for ASD closure for children, young females below 30 and selected adult male patients with lean body built. Retrospective analysis of these patients with conventional median sternotomy approach over a period of 3 years in this center was included, excluding patients with ostium primum. ASD and associated conditions like PDA, VSD, Mitral valve prolapse, coronary artery disease etc. Common variables including pump time aortic cross clamp time, postoperative ventilation, ICU stay, morbidity were considered for analysis. There were 225 (130 male and 95 females) patients in sternotomy group vs 96 (65 males and 30 females) in RPLT group. The average age in sternotomy group was 36 years (range 2 to 46 years) as compared to 13 years (range 3 to 27 years). Direct closure of ASD was done in 71 patients and pericardial patch closure for 154 patients in sternotomy group, compared with 66 and 20 in the RPLT group.Results: Extra corporeal circulation time was 46 minutes (37 to 90) in sternotomy group, Aortic cross clamp time 22 minutes (18 to 38) in former as compared to 32 minutes (28 to 45) 14 (8 to 36) in the latter. Blood loss in postoperative period was 210 ml (range 40 600 ml in sternotomy group while it was 160 ml range 20 400 ml) in thoracotomy group. Selective ventilation was provided in all patients. Postoperative complications included ( 3 vs. 1). The opening sternal rewiring (31 pain and shoulder movement restriction (12), and secondary suturing (5 patients in RPLT group). The cosmetic appeal of the incision was acceptable for most of the parents of female patients in thoractomy group.Conclusions: Right posteroilateral thoracotomy for ostium scundum ASD closure in a suitable approach as it gives equally good results as median Sternotomy. Patient selection is an important factor.Background: Successful neonatal repair of infradiaphragmatic total anomalous pulmonar T drainage (TAPVD) depends largely on early intervention which in tmn is dependent on early diagnosis, referral and transportation.Methods: Five neonates underwent complete repair of isolated infradiaphragmatic (Obstructed) TAPVD from January 1995 to November 2003. All patients were referred from distant places. Two were males, ages ranged from 6 days to 35 days. Emergency operative correction was performed after instituting resuscitative measmes. The common confluence to LA anastomosis was done, vertical vein ligated and ASD closed in all cases. The mean CPB time was 80 min.