Introduction To Right Anterior Minithoracotomy Subaortic Membrane Resection
Juan A. Siordia, Jr., MD, Peter A. Knight.
University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE: Subaortic membranes are a congenital heart defect that cause discrete subaortic stenosis and aortic insufficiency. Current standard treatment is performing a subaortic membrane resection via a median sternotomy. We present the first case of a subaortic membrane resection performed in an adult patient via a right anterior minithoracotomy with video guidance.
METHODS: A subaortic membrane resection was performed via a right anterior 5 cm minithoracotomy in the second intercostal space. Cardiopulmonary bypass was installed via central arterial and peripheral venous cannulation. After placement of an aortic cross clamp and delivery of antegrade cardioplegia, an aortotomy revealed the aortic valve. Videoscopy provided further evaluation of the valve and the subaortic membrane. Shafted instruments and scalpels completed a partial septal myectomy and subaortic membrane resection. After careful inspection of the left ventricular outflow tract with the endoscope, the operation was closed in a traditional fashion.
RESULTS: Total aortic cross clamp and cardiopulmonary bypass times were 45 and 63 minutes, respectively. Post-bypass transesophageal echocardiography presented complete removal of the subaortic membrane, a mean gradient of 5 mmHg, and trivial aortic regurgitation. The patient was transferred to the intensive care unit while intubated. Extubation occurred 6 hours after the procedure, and the patient was transferred to the floor on postoperative day 1. Pain was controlled orally and the patient was able to ambulate on postoperative day 2. Her hospital course remained uneventful and was discharged on postoperative day 3. Three-week follow-up revealed no new symptoms or complaints.
CONCLUSIONS: A right anterior minithoracotomy subaortic membrane resection is feasible and effective in adult cardiac patients. Patients acquire less postoperative complications including pain or hemorrhage. They are also much more satisfied with having minimal trauma and a quick recovery.
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