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. Principally for cosmetic reasons, anterolateral thoracotomy is frequently used for closure of atrial septal defect in young female patients. However, in anterolateral thoracotomy, the skin incision frequently crosses the future breast line, which may cause breast and pectoral muscle maldevelopment.

Methods. We review the long-term results of a consecutive series of 126 patients in whom the atrial septal defect was closed through a right posterolateral 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 patients were pleased with their cosmetic results. There were no other late complications.

Conclusions. Atrial septal defect can be safely repaired through a right posterolateral thoracotomy approach. This approach offers the benefit of a total absence of scarring and cosmetic disfigurement of the anterior chest wall.     

Closure of atrial septal defects via limited right anterolateral thoracotomy as a minimal invasive approach in female patients.

OBJECTIVE: The closure of atrial septal defects via sternotomy is a low-risk and high-benefit procedure. Limited right anterolateral thoracotomy is an alternative approach with regard to cosmetic aspects. However, it is discussed that a lateral approach is not appropriate for more complex lesions and is associated with an increased incidence of phrenic nerve damage. METHODS AND RESULTS: The perioperative and long-term outcomes (mean follow-up time: 73.2 months) of 87 female patients, mean age 20.4 years (range: 3-56 years), operated on for all types of atrial septal defects via limited right anterolateral thoracotomy between 1982 and 1993, were analysed retrospectively. Special features of the operation technique were a limited skin incision, protection of mammary gland tissue, prevention of phrenic nerve damage, and aortic cannulation in all patients. There were no intraoperative complications. Postoperative complications occurred in 12/87 patients including one rethoracotomy for postoperative bleeding and one late pericardial tamponade due to coumadine overdose. Follow-up was assessed by a survey obtained by the patients or their parents, and their family doctors in 79 patients (90.8%) Cardiac symptoms, mostly supraventricular arrhythmias, were observed in 13.9%. Echocardiography revealed mild tricuspid valve regurgitation (one patient) and mild mitral valve incompetence (one patient with ostium primum defect); there were no residual shunts. Cosmetic results were considered good and excellent in 87.3% and satisfactory in 8.9%. Three patients (3.8%) complained of a broad scar. Anaesthetic areas and optional scar pain were quite frequent (16.5%), whereas restriction of shoulder movement, breast asymmetry and scoliosis were rare. In summary, only one patient, suffering from intercostal neuralgia, would prefer sternotomy. CONCLUSION: Limited right anterolateral thoracotomy has a high cosmetic acceptance and was proven to be safe and effective for closure of any kind of atrial septal defects. Therefore, it is recommended as standard approach for atrial septal defects especially in female patients. reserved.     

远端融合节段选择对退变性脊柱侧后凸患者矫形术后骨盆入射角变化的影响

目的:探讨远端不同融合节段对退变性脊柱侧后凸患者矫形术后骨盆入射角(pelvic incidence,PI)变化的影响.方法:回顾性分析2010年5月～2018年4月因退变性脊柱侧后凸于我院行后路矫形长节段融合内固定手术患者的病历资料,男5例,女37例;年龄50～69岁(60.6±6.9岁).按远端融合节段不同分为两组...     

经右前外侧肋间小切口心脏多瓣膜手术154例中期疗效随访的回顾性队列研究

目的 分析经右前外侧肋间小切口心脏多瓣膜手术的早期疗效中期随访结果,探讨手术的安全性、有效性与外科医生学习曲线.方法 回顾性分析2015～2019年空军军医大学第一附属医院心血管外科完成的154例经右前外侧肋间小切口多瓣膜手术的临床资料.男103例,女51例,年龄23 ～ 68岁,全部手术经股动、静脉建立闭式体外循环,...     

右胸弯型女性青少年特发性脊柱侧凸患者乳房发育的不对称性

目的:评估右胸弯型女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者乳房的不对称性及其与脊柱畸形指标和前胸壁畸形指标的相关性.方法:2010年6月～2011年6月在我院接受手术治疗的73例右胸弯型女性AIS患者,Lenke Ⅰ型63例,LenkeⅡ型10例,手术年龄11～21岁,平均14.82±2.69岁;主胸弯Cobb角40°～90°,平均52.08°±11.68°.术前均行全脊柱CT扫描,采用Image J软件进行三维重建,测量凹、凸侧乳房体积(breast volume,BV),同时在二维CT图片上测量乳房外倾角、乳房覆盖角、乳房下胸壁角、乳头至胸骨中线距离、乳房轴高及乳房纵高.乳房不对称性指数(breast asymmetry index,BAI)定义为(凹侧-凸侧)BV/[(凹侧+凸侧)BV]/2,BAI＞5％或＜-5％时定义为凹凸侧乳房不对称.脊柱畸形指标包括RAsag角和RAml角.采用配对t检验分析凹、凸侧乳房各指标的不对称程度,用Pearson相关分析研究BAI与脊柱畸形指标之间的相关性以及乳房指标和前胸壁指标之间的相关性.结果:凹侧BV、乳房外倾角、乳房轴高及乳房纵高分别为283.19±153.89ml、26.32°±9.68°、29.28 ±7.26mm、17.42±6.35cm,均显著大于凸侧的257.42±149.85ml、23.41°±8.24°、27.88±7.70mm、16.73±6,41cm (P＜0.05);凹侧乳房覆盖角及乳房下胸壁角分别为95.39°±8.42°、57.61°±8.49°,均显著小于凸侧的106.34°±9.57°、61.43°±6.73°(P＜0.05).凹、凸侧乳头至胸骨中线距离无显著性差异(P＞0.05).BAI平均值为11.4％,其凹侧BV大于凸侧的比率为80.8％,凹凸侧BV不对称的比率为78.1％.BAI达10％以上的分别为52.1％(凹侧＞凸侧)和4.1％(凹侧＜凸侧).BAI与Cobb角、RAsag角和RAml角之间均无显著相关性(r=0.049、-0.050、0.037,P＞0.05),而乳房下胸壁角与乳房外倾角及乳房覆盖角之间均呈显著相关性(r=-0.857,P＜0.001;r=0.411,P＜0.001).结论:大部分右胸弯型女性AIS患者存在凹侧乳房大、凸侧乳房小的不对称性特征.相对于凸侧乳房,凹侧乳房更外倾、更集中(轴高高且覆盖胸壁角度小).乳房下胸壁的倾斜角度对乳房的方向和覆盖范围有显著的影响,提示BV不对称及胸壁畸形共同参与乳房外观畸形的构成.     

Towards an easier and safer reoperation of the atrioventricular valves: the right anterolateral thoracotomy approach without pericardial dissection

A simple technique for quicker and safer "redo" operations, is presented. The atrioventricular valves are approached through a right anterolateral thoracotomy without pericardial dissection.     

The incidence of Klippel-Feil syndrome in patients with congenital scoliosis and kyphosis

A retrospective review of the radiographs of 1215 patients with congenital scoliosis and kyphosis disclosed 298 (25%) to have segmentation defects in the cervical spine. A single level defect was seen in 82 patients, 52 of which were at C2-C3. Of the 298 patients, 235 had scoliosis, (6 cervical, 42 cervicothoracic, 75 thoracic, 4 thoracolumbar, and 1 lumbar), 36 had kyphoscoliosis, 10 lordoscoliosis, and 17 pure kyphosis.     

Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin

Background : Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. Methods : The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. Results : In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25–70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25–18.5 years). Eighty‐seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had ‘dense mammograms’, all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. Conclusion : The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.