Horizontal right axillary minithoracotomy: aesthetic and effective option
for atrial and ventricular septal defect repair in infants and
toddlers |
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Authors: | Luciana da Fonseca da Silva José Pedro da Silva Aida L R Turquetto Sonia Meiken Franchi Cybelle M Cascudo Rodrigo Moreira Castro Walter José Gomes Christian Schreiber |
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Institution: | 1. Escola Paulista de Medicina da Universidade Federal de São Paulo, (UNIFESP/EPM), São Paulo, SP, Brazil;2. Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil;3. Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Munich, Germany |
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Abstract: | Introduction Congenital heart defects treatment shows progressive reduction in morbidity and
mortality, however, the scar, resulting from ventricular (VSD) and atrial septal
defect (ASD) repair, may cause discomfort. Right axillary minithoracotomy
approach, by avoiding the breast growth region, is an option for correction of
these defects that may provide better aesthetic results at low cost. Since October
2011, we have been using this technique for repairing VSD and ASD defects as well
as associated defects. Objectives To evaluate the efficacy of this method in children undergoing correction of VSD
and ASD, to compare perioperative clinical outcomes with those repaired by median
sternotomy, and to evaluate the aesthetic result. Methods Perioperative clinical data of 25 patients submitted to axillary thoracotomy were
compared with data from a paired group of 25 patients with similar heart defects
repaired by median sternotomy, from October 2011 to August 2012. Results Axillary approach was possible even in infants. There was no mortality and the
main perioperative variables were similar in both groups, except for lower use of
blood products in the axillary group (6/25) vs. control (13/25),
with statistical difference (P =0.04). The VSD size varied from 7
to 15 mm in axillary group. Cannulation of the aorta and vena cavae was performed
through the main incision, whose size ranged from 3 to 5 cm in the axillary group,
with excellent aesthetic results. Conclusion The axillary thoracotomy was effective, allowing for a heart defect repair
similar to the median sternotomy, with more satisfactory aesthetic results and
reduced blood transfusion, and it can be safely used in infants. |
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Keywords: | Heart Septal Defects Ventricular Heart Septal Defects Atrial Surgical Procedures Minimally Invasive |
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