VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR THE TREATMENT OF CONGENITAL CARDIAC DEFECTS IN THE PEDIATRIC POPULATION

Recent technologic advances have contributed to a renewed interest in thoracoscopic surgery. In our institution, thoracoscopy through video- assisted technology has been successfully applied to congenital heart surgery. We reviewed the charts of 45 consecutive patients (ASA physic al status II-IV) who underwent video-assisted thoracoscopic surgery (V ATS) for various congenital heart defects. The mean age of the patient s was 2.65 yr and the mean weight was 11.78 kg. The surgical procedure s included patent ductus arteriosus interruption (n = 28) and vascular ring division (n = 8), and 9 patients had miscellaneous procedures. T he most commonly used anesthetic regimen consisted of isoflurane, panc uronium, fentanyl, air, and oxygen. Seven patients were managed with o ne-lung ventilation, the remainder by two-lung ventilation with surgic al lung retraction. Intraoperative desaturation occurred in 12 patient s (26.7%) but resolved quickly with brief reexpansion of the lungs. Po stoperative complications included: pleural effusions (n = 3), chyloth orax (n = 2), right upper lobe atelectasis (n = 1), small pneumothorax (n = 1), and vocal cord paralysis (n = 1). Seven patients (15.5%) req uired conversion to a thoracotomy for insufficient exposure (n = 4) or due to concern over bleeding (n = 3). This experience with VATS in pe diatric patients with congenital heart disease may provide a database for comparison with others who work with the VATS technique.