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International Society For Minimally Invasive Cardiothoracic Surgery

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Surgical Maneuver For VSD Exposure During Congenital Heart Surgery Through The Right Transverse Axillary Minithoracotomy
Volodymyr Demianenko, Oleksandr Babliak.
Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network, Kyiv, Ukraine.

BACKGROUND: Right transverse axillary minithoracotomy is not conventionally used for VSD repair because of complicated VSD exposure and need of temporary tricuspid valve leaflet detachment to facilitate VSD exposure. Recently our team developed a new surgical maneuver, not described before, which markedly facilitates VSD exposure without need for tricuspid valve leaflet detachment.
METHODS: Abovementioned VSD exposure maneuver was used in 10 patients with age range from 2 months to 11 years and body weight from 5 to 47 kg.The length of the incision varied from 3.5 to 4 cm over the 4th ICS. Central CPB cannulation with wire reinforced venous cannulas was performed. Antegrade blood cardioplegia was administered. Bended/angled instruments were used throughout the procedure to facilitate the surgeon's view. Pericardial sutures and rotating the heart have been used as general exposure maneuvers. Special surgical maneuver aimed at changing the general plane of the ventricular septum consisted of one intraventricular exposing suture.
RESULTS: Sufficient exposure of perimembranous VSD was obtained in all patients in whom exposing maneuvers were used. Exposure was comparable to what is usually obtained through the median sternotomy, as it shown in the video.
CONCLUSIONS: With the use of the new maneuver all perimembranous VSD could be safely exposed and repaired with the conventional technique through the right transverse axillary minithoracotomy starting from the 2 months of age.


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