Fc. Riess et al., Correction of congenital heart defects and mitral valve operations using limited anterolateral thoracotomy, HEART SUR F, 4(1), 2001, pp. 34-39
Purpose: Median sternotomy, which generally is used as a standard access fo
r atrial septal defect (ASD) and mitral valve operations, has a significant
risk of postoperative instability/osteomyelitis of the sternum. Moreover,
especially in young women, the resulting large scar is a poor cosmetic resu
lt that may have adverse psychological consequences. Our presentation sugge
sts that these difficulties may be avoided by the use of a less invasive ap
proach consisting of a limited anterolateral thoracotomy with standard cann
ulation.
Material and methods: From June 1997 until December 1999, 13 women, mean ag
e 31.9 +/- 9.2 years, with atrial septum defect (n = 8), sinus venosus defe
ct with partial anomalous pulmonary venous connection (n = 1), left atrial
myxoma (n = 1) or mitral valve regurgitation (n = 3), were scheduled for le
ss invasive operation. In all cases a double lumen tube was used for ventil
ation. After a submammarian skin incision of about 10 cm a limited anterola
teral thoracotomy was performed in the fifth right intercostal space. For c
annulation of the ascending aorta a trochar cannula was used. Both caval ve
ins were cannulated by angled vena cava catheters. Standard cardiopulmonary
bypass was established using normothermia in all patients undergoing opera
tions with correction of congenital heart defects and mild hypothermia (32
degreesC) in the three patients undergoing mitral valve operation. Surgery
was performed in cardioplegic arrest using Bretschneider's solution. Ail co
rrections of congenital heart defects were performed by Goretex(R) patches.
Mitral valve reconstruction was carried out in two patients, and one patie
nt underwent mitral valve replacement.
Results: No complications occurred in any of the 13 patients peri- or posto
peratively. Total time of operation was 211.9 +/- 36.0 minutes, the perfusi
on time was 77.0 +/- 25.8 minutes, and the aortic cross-clamp time was 51.8
+/- 21.9 minutes. Mean stay in ICU was 1.2 +/- 0.4 days (total hospital st
ay: 7.8 +/- 2.2 days). Postoperative thoracic x-ray and cardiac echocardiog
raphy/dopplersonography revealed no pathological findings in any patients.
Conclusion: Atrial septal defect operations, including partial anomalous pu
lmonary venous connection, left atrial myxoma and mitral valve operations,
can be performed safely and effectively using a limited anterolateral thora
cotomy and standard cannulation technique with excellent cosmetic results.