Repair of atrial septal defect through a right posterolateral thoracotomy:A cosmetic approach for female patients

Background. Because the operation for atrial septal defect is considered a low-risk procedure, the cosmetic result has become an important issue. Prin cipally for cosmetic reasons, anterolateral thoracotomy is frequently used for closure of atrial septal defect in young female patients. However, in a nterolateral thoracotomy, the skin incision frequently crosses the future b reast line, which may cause breast and pectoral muscle maldevelopment. Methods. We review the long-term results of a consecutive series of 126 pat ients in whom the atrial septal defect was closed through a right posterola teral thoracotomy. The mean age at operation was 7.1 years (range, 1 to 15 years), and the mean body weight was 23.9 kg (range, 6.9 to 56 kg). Defects repaired included 121 ostium secundum (central type), 3 sinus venosus, and 2 ostium secundum without inferior margin. Results. The average cardiopulmonary bypass time was 65 minutes (range, 37 to 130 minutes), with an average fibrillation time of 41 minutes (range, 23 to 70 minutes). There was no operative or late mortality. A majority of pa tients were pleased with their cosmetic results. There were no other late c omplications. Conclusions. Atrial septal defect can be safely repaired through a right po sterolateral thoracotomy approach. This approach offers the benefit of a to tal absence of scarring and cosmetic disfigurement of the anterior chest wa ll. (C) 2001 by The Society of Thoracic Surgeons.