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Cervical Cannulation for Surgical Repair of Congenital Cardiac Defects in Infants and Small Children
Abstract:
Objective: Minimal invasive cardiac surgery has become an established technique for correction of wide variety of acquired and congenital cardiac lesions. However, it is yet to become an accepted technique in pediatric population. Amongst hurdles faced in conduct of minimal invasive cardiac surgery in pediatric population, one of the biggest challenges is peripheral vascular cannulation. We report our technique and results of use of peripheral cannulation in infants and small children for repair of simple congenital cardiac defects.
Methods: October 2014 to September 2015, 37 children (21 male) with mean age of 1.5 years (8 months-6years) and mean weight 8Kg (5.2Kg-13.5Kg) were operated for simple congenital cardiac defects through right lateral thoracotomy or transxiphoid incision (ventricular septal defect (VSD) (18 patients), ostium secundum atrial septal defect (OS-ASD) (10 patients), sinus venosus ASD (4 patients), partial atrioventricular canal defects (4 patients), and OS-ASD with pulmonary stenosis (1 patient). The length of thoracic or xiphoid incision ranged from 4 to 5cm and cervical incision was 1.5-2cm. In all patients, right common carotid artery (RCCA), right internal juglar vein (RIJV) and inferior vena cava (IVC) was cannulated for conduct of cardiopulmonary bypass and aorta cross clamped through right 2^nd intercostals space. Intracardiac defects were repaired as with full sternotomy technique except that anterior leaflet of tricuspid valve was detached routinely for exposure VSD. Perioperative and postoperative echocardiography was performed in all the patients. Follow-up was complete.
Results: There was no mortality or significant surgical morbidity. There was vascular or no neck wound related complications and no patient had any neurological event. All patients were in sinus rhythm. Perioperative and postoperative echocardiography confirmed the absence of any residual defects in any patient. Two patients with VSD had tiny flow across patch. No patient had any significant tricuspid regurgitation.
Conclusions: peripheral vascular cannulation using graft on RCCA and direct cannulation of RIJV is safe and easy to perform. It prevents the cluttering of operative field and provides excellent exposure even in infants.