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OBJECTIVE: To assess the clinical efficacy of 24 cases of minimally invasive approach for congenital heart defects and to sum up experiences and the main points of the operation.
METHODS:
From September 2010 to November 2011, 24 patients (median age 16.3years; range, 1~45 years) underwent a minimally invasive approach for congenital heart defects. All patients of 17 ventricular septal defects (VSD) and 7 atrial septal defects (ASD) were treated through minimally invasive approach, out of which 12 cases were totally performed by totally thoracoscopic surgery and 12 transthoracic device closures were performed without cardiopulmonary bypass via a small subxiphoid incision . In thoracoscopic surgery group, we used three 3 incisions in the chest wall:the first was in the 4th parasternal intercostal space, the second in the right 3rd intercostal space of media axillary line, and the third in the right 7th intercostal space of media axillary line. All the incisions were less than 3 cm.The cardiopulmonary bypass was established by femoral artery and vein in the right groin. In Subxiphoid Device Closure group, patients underwent device closure under transesophageal echocardiographic(TEE) guidance, without cardiopulmonary bypass via a small subxiphoid incision . we splited the inferior 1/3 of sternum and incised pericardium partially to expose the surface of the right atrium or right ventricular and choosing the most obvious place of the tremors as the puncture point, we punctured the surface of the right atrium or right ventricular by a trocar, and set up conveying road under the guidance of TEE.Then we released occluder through the conveying road which was confirmed the right position by TEE.
RESULTS: There was no mortality and significant surgical morbidity. Follow-up was completed and ranged from 1 to 12 months (median, 8.8 months), no serious complications except for one case with postoperative hemoglobinuria for 3 days.
CONCLUSIONS:
Minimally invasive closure or repair of Congenital heart defects by totally thoracoscopic surgery in patients can be safe and effective. The cosmetic results are excellent