MINIMALLY INVASIVE ATRIAL SEPTAL DEFECT REPAIR THROUGH SUBAXILLARY RIGHT THORACOTOMY (‘BIKINI INCISION’) IN CHILDREN and YOUNG ADULTS

Abstract

OBJECTIVE The minimally invasive techniques in the treatment of congenital heart diseases have widely expanded recently both in terms of cosmetic results and patient comfort. In this report, we aimed to present our results of patients with the diagnosis of atrial septal defect and associated intracardiac pathologies who were operated through subaxillary mini thoracotomy. MATERIAL and METHOD Seven patients who underwent subaxillary mini thoracotomy out of 53 patients with atrial septal defect that were operated with minimally invasive techniques in our clinic between 2009 and 2020 were identified. Six of the patients (85%) were girls and one was a boy (15%) and the mean age at operation was 8.1  15.8 years. RESULTS Three patients had secundum atrial septal defect with a deficient septal rim; two patients had primum atrial septal defect, mitral cleft and mild mitral regurgitation and two patients had atrial septal defect, partial pulmonary venous return of the right pulmonary veins. All of the intracardiac pathologies were treated through right subaxillary mini thoracotomy. The mean cardiopulmonary bypass times and aortic cross clamp times were 71.5  19.2 and 44.4  22.1 minutes, respectively. Our patients were uneventfully discharged in 5.2  0.4 days. We did not encounter and morbidity or mortality in a mean follow up period of 4.4  3.1 years. CONCLUSIONS The postoperative wound healing is faster and wound related complications are less frequently seen in patients undergoing cardiac surgery performed with minimally invasive techniques. The selection of subaxillary thoracotomy provides advantages both in terms of cosmetic aspects and breast development not being affected negatively.

Keywords

• congenital heart disease
• atrial septal defect
• mitral cleft
• partial abnormal pulmonary venous return

ÇOCUKLARDA ve GENÇ ERİŞKİNLERDE SUBAKSİLLER SAĞ TORAKOTOMİ YAKLAŞIMIYLA (‘BİKİNİ İNSİZYONU’) MİNİMAL İNVAZİV ATRİYAL SEPTAL DEFEKT ONARIMI

Öz

AMAÇ Son yıllarda doğumsal kalp hastalıklarının cerrahi tedavisinde minimal invaziv yöntemler gerek kozmetik gerek hasta konforu açısından ön plana çıkmıştır. Biz bu yazıda atriyal septal defekt ve eşlik eden intrakardiyak patolojilerde subaksiller mini torakotomi ile ameliyat ettiğimiz hastalarımızın sonuçlarını sunmayı hedefledik. MATERYAL ve METOT Kliniğimizde 2009 – 2020 yılları arasında minimal invaziv tekniklerle atriyal septal defekt ve ek intrakardiyak patoloji onarımı yapılan 53 hastadan subaksiller mini torakotomi ile opere edilen yedi hasta retrospektif olarak incelendi. Hastaların altısı kız (%85) biri erkek (%15) olup ameliyat sırasındaki ortalama yaşları 8.1  15.8 yıldı. BULGULAR Üç hastada sekundum ASD ve septal rim yokluğu, iki hastada primum ASD, mitral kleft ve hafif mitral yetmezlik ve iki hastada da high venosum ASD ve sağ pulmoner venlerin parsiyel anormal pulmoner venöz dönüş anomalisi mevcuttu. Hastalarda tüm intrakardiyak patolojiler sağ subaksiller torakotomi yaklaşımı ile onarıldı. Hastalarda ortalama kardiyopulmoner bypass süresi ve aortik klemp süresi sırasıyla 71.5  19.2 dakika ve 44.4  22.1 dakika olarak gerçekleşti. Hastalarımız ortalama 5.2  0.4 günde sorunsuz taburcu edildi. 4.4  3.1 yıl takip süresinde herhangi bir morbidite veya mortalite ile karşılaşılmadı. SONUÇLAR Minimal invaziv tekniklerle gerçekleştirilen kardiyak cerrahi girişimlerinde ameliyat sonrası iyileşme süresi daha kısa olup yara iyileşme sorunları daha az görülmektedir. Özellikle puberte öncesi kız çocuklarda subaksiller torakotomi yaklaşımın tercih edilmesi hem kozmetik hem de meme gelişiminin olumsuz yönde etkilenmemesi açısından avantaj sağlamaktadır.

Anahtar Kelimeler

• doğumsal kalp hastalıkları
• atriyal septal defekt
• mitral kleft
• parsiyel anormal pulmoner venöz dönüş

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