Mini Thoracotomy For ASD Closure In A Patient With Large Breast Implants
Baptist Health South Florida/Florida International University, Miami, FL, USA.
Background: Mini thoracotomy has become a safe and less invasive technique to perform cardiac surgery. In patients with breast implants this approach may be challenging. Literature in this area is scarce. Herein we present a female with large breast implants who required surgical repair of an atrial septal defect.
Methods: A 53-year-old woman presented to the emergency room complaining of a several week history of shortness of breath and mild chest pain. She had had bilateral breast augmentation with silicon implants six years before her admission. Cardiology work-up revealed a large secundum atrial septal defect with left to right shunting (Qp/Qs 2.2) and enlarged right sided chambers. Patient was not a good candidate for percutaneous approach, and she was referred for surgical closure. On physical exam the breast was soft with no evidence of capsular contracture. The case was discussed with plastic surgery for advice.
Results: Right mini thoracotomy was performed through her previous inframammary incision. The breast implant capsule was carefully opened widely, the silicone implant was removed and placed in a basin with betadine solution. The fifth intercostal space was opened; Cardiopulmonary bypass was instituted femorally and the aorta was cross clamped. A single dose of custodiol cardioplegia was given. The large secundum ASD was closed with a 3 x 4 cm pericardial patch. The patient was weaned off cardiopulmonary bypass. The intercostal space was reapproximated with a figure 8 heavy suture; the posterior aspect of the implantís capsule was closed with a running suture to prevent implant migration. The breast implant was then placed back, and the remaining capsule closed with a continuous suture. Subcutaneous tissue and skin were closed in standard fashion. The patient was discharged home on POD 3 and was seen for follow up three weeks later with no issues.
Conclusion: Minimally invasive cardiac surgery can be performed safely in patients with large breast implants. Several factors such as implant age and capsule assessment need to be considered before surgery. Careful handling of the implant and closure of the posterior aspect of the capsule are of paramount importance to prevent complications.
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