Minimal Posterior Axillary Thoracotomy and Muscle Spare Technique for Female Infants with Congenital Heart Diseases
Fuwai Hospital Beijing, Bejing, China.
OBJECTIVE: To evaluate the surgical outcomes of minimal posterior axillary thoracotomy and muscle spare technique on female infants with simple congenital heart diseases.
METHODS: From April 2008 to October 2015, 586 female infants underwent surgical repair for simple congenital heart diseases by one surgeon with the approach of posterior axillary thoracotomy. The approaches of all the surgery were through thoracotomy with minimal right posterior axillary incisions and muscle spare technique to avoid breast development issues. The age of the patients ranged from 7 months to 6 years old (mean is 14 months ), with body weight 7 to 30 kg(mean is 13kg). The cohort of the patients consists of 156 atrial septal defects(ASD), 388 ventricular septal defects(VSD), 8 partial atrialventricular septal defects, 2 cor triatriatum, 9 partial anomalous pulmonary vein connecton(PAPVC), 23 ventricular septal defects with anomalous muscle bundle in right ventricles. The associated anomalies include left superior vena cava(LSVC), patent ductus arteriosus(PDA), mitral insufficiency and tricuspid insufficiency. The cardiopulmonary bypass time ranges from 25 minutes to 81 minutes(mean is 45 minutes), The cross clamp time ranges from 6 minutes to 51 minutes. The length of incision ranges from 2 to 4.5 cm.
RESULTS: There was no mortality and no major complication. Three patients needed re-pump run for residual lesion. Eight patients had minimal residual VSDs and did not need intervention, had pneumothorax and recovered soon after surgery. All the patients are doing well during follow-up period.
CONCLUSIONS: Minimal right posterior axillary thoracotomy with muscle spare technique is a very safe and reliable approach for female infants with congenital heart diseases. The more posterior incision is anticipated to have less concern of breast development issue as well as provides a cosmetic effect
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