Thoracoscopic Repair Of Incomplete Atrioventricular Septum Defect
Rodrigo Ribeiro de Souza, Tercio Campos Leão Neto, Lucas Henrique Prado Sousa, Janduy Gil de Sousa Silva, Jeffchandler Belém de Oliveira.
Hospital São Francisco de Assis, Goiania, Brazil.
BACKGROUND - Partial, Incomplete, atrioventricular septal defect is a prevalent congenital disorder and must be researched by aiming to reach a surgical technique with minimally invasiveness and best results possible.
METHODS - To report the case of a 10 year old female patient with partial defect of the atrioventricular septum, with consequent damage in the execution of their daily activities, whose correction was made by means of surgical technique minimally invasive thoracoscopy. The ostium primum type ASD results from the abnormality of the cushions atrioventricular, poor embryological formation, with difficulties of anchoring the atrial septa and may be associated with other anomalies due to defects in the cushions, such as septal leaflet fissure of the mitral valve known as a Cleft as in the case in question. The therapeutic option of choice was surgical correction through the use of thoracoscopy, which enabled the procedure without direct vision and without sternotomy.
RESULTS - The procedure was conducted with no accidents, CPB was conductes using a jugular, femoral, femoral cannulation and a 2 inches incision posterior of the midclavicular line on the 4th intercostal space. The total CPB was 60 minutes and aortic crossclamp 45 minutes. There was minimal blood loss and tha repair of the mitral cleft was done using separate stiches and a pericardical patch for the ASD closure. The patient stayed in ICU for 18 hours and after removing the thoracic drain she was discharged to the ward. There were only 150ml of drainage volume. On the third postoperative day she was discharged home. She was cleared to all her normal activities without any restriction on postoperative day 10.
CONCLUSIONS -This technique permits less aggression to the patient, allowing in some cases extubation of the patient still inside the operating room, right before being referred to ICU, known as FAST TRACK. In addition to that are notable a lower inflammatory response, lower intra and postoperative bleeding, with consequent reduction of ICU and hospital length of stay.
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