Right posterolateral thoracotomy for paediatric open heart surgery: Indications and results.

In order to avoid the aesthetic prejudice of median sternotomy in young chi ldren undergoing open heart surgery for isolated congenital heart disease, a right posterolateral thoracotomy was performed in 146 children aged 5 mon ths to 14 years. The large majority (140/146, 96%) were atrial septal defects : 130 ostium s ecundum, 5 sinus venosus, 1 low septal defect and 4 ostium primum (partial endocardial cushion defect). Six children had isolated perimembranous ventr icular septal defects. One patient died of a probable lesional pulmonary oe dema. Minor complications were observed in 15 cases and one had to be reope rated for a residual shunt. With an average follow-up of 2.6 years, all survivors are asymptomatic. The scar is normal, without cheloid or thoracic deformation, invisible to the patient when he looks in a mirror. The use of this approach requires a very accurate anatomical diagnosis, especially with regards to systemic and pul monary drainage. The presence of a left superior vena cava draining into th e coronary sinus is a contra-indication. The right posterolateral thoracotomy is now the approach of choice in its s tandard indication, the repair of ostium secundum atrial septal defects wit h large shunts, in young girls under 10 years of age.