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Totally Thoracoscopic Surgical Closure of Atrial Septal Defect in Children
Zhao-Yun CHENG,Feng WANG, M.D. , M.D. De-Guang FENG, M.D.
Institute of Cardiovascular Surgery, Henan Provincial People''s Hospital, Zhengzhou, Henan 450003 P.R.CHINA
BackgroundThis study assesses the approaches and the advantages of totally thoracoscopic cardiac surgery as an emerging alternative to the traditional median sternotomy procedure in children with low body weight.
MethodsFrom March 2009 to October 2011, 39 pediatric patients( 31 females ) with a mean age of 5.8 ± 2.1 (4.5~8 ) years and body weight of 15.0 ± 4.65 (13.5~22) Kg underwent totally thoracoscopic atrial septal defect (ASD) closure. There were 31 ostium secundum defects and 8 sinus venosus defects with partial anomalous pulmonary venous connection. Mean defect sizes were 18 ± 11.6 (range,12~42 )mm. Patients with aortic regurgitation, small femoral arteries or veins, arteriosclerotic diseases of the aorta or the femoral arteries, and body weight less than 13 kg were excluded from the operation as a contraindication to the technique. The operation was undertaken under video assistance and direct vision without opening the chest. Double lumen endotracheal intubation ventilation was applied, with the patient supinely positioned and the right hemithorax slightly elevated (~ 30°). Femoral artery was cannulated with 10F or 12F cannula whereas the femoral vein and the superior vena cava with 19F and 20F cannula, respectively. Intraoperative TOE where applied for every patient. Three skin incisions of 1.0~2.5 cm each were made on the right chest wall. Direct suture closure were made in 25 patients, whereas Dacron patches repair were performed in the remaining 14 cases. Results. No operative death or major intraoperative complication including significant residual shunts was observed. All patients had a regular hospital course with minimal chest pain and discomfort.
Conclusions. Totally thoracoscopic surgical ASD closure in low body weight children is feasible, minimally invasive, safe, with good cosmetic effects. Routine use of this technique can be reached by careful selection of indicated patients and fundamental understanding of the thoracoscopic approach.