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

Year 2020, Volume: 8 Issue: 3, 507 - 514, 20.12.2020

Arda Özyüksel , Baran Şimşek , Pelin Kocapehlivan Şener Demiroluk Murat Saygı Mehmet Bilal

https://doi.org/10.37696/nkmj.807330

Abstract

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.

Keywords

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

Thanks

Yazarlar şekil çizimi için Sabri Çağrı Sezgin'e teşekkür eder.

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

References

• 1. Deanfield J, Thaulow E, Warnes C, Webb G, Kolbel F, Hoffman A et al. Management of grown up congenital heart disease. Eur Heart J. 2003;24(11):1035-1084.
• 2. Liava M, Kalfa D. Surgical closure of atrial septal defects. J Thorac Dis 2018;10(Suppl 24):S2931-S2939.
• 3. Murray G. Closure of Defects in Cardiac Septa. Ann Surg 1948;128(4):843-852.
• 4. Lewis FJ, Taufic M. Closure of atrial septal defects with the aid of hypothermia; experimental accomplishments and the report of one successful case. Surgery 1953;33(1):52-59.
• 5. Khan JH, McElhinney DB, Reddy VM, Hanley FL. Repair of secundum atrial septal defect: limiting the incision without sacrificing exposure. Ann Thorac Surg 1998;66(4):1433-1435.
• 6. Nicholson IA, Bichell DP, Bacha EA, Del Nido PJ. Minimal sternotomy approach for congenital heart operations. Ann Thorac Surg 2001;71(2):469-472.
• 7. Heinisch RP, Wildbolz MW, Beck MJ, Bartkevics M, Gahl B, Eberle B et al. Vertical Right Axillary Mini-Thoracotomy for Correction of Ventricular Septal Defects and Complete Atrioventricular Septal Defects. Ann Thorac Surg 2018;106(4):1220-1227.
• 8. King TD, Mills NL. Nonoperative closure of atrial septal defects. Surgery 1974;75(3):383-388.
• 9. King TD, Thompson SL, Steiner C, Mills NL. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 1976;235(23):2506-2509.
• 10. Mavroudis C, Backer CL, Stewart RD, Heraty P. The case against minimally invasive cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005;193-197.
• 11. Barratt-Boyes BG, Simpson M, Neutze JM. Intracardiac surgery in neonates and infants using deep hypothermia with surface cooling and limited cardiopulmonary bypass. Circulation 1971;43(5):I25-30.
• 12. Aksüt M, Özer T, Yerlikhan ÖA, Selçuk E, Yanartaş M. Sağ̆ mini torakotomi ile gerçekleştirilen minimal invaziv kalp cerrahisi prosedürlerinde başlangıç̧ tecrübelerimiz. Koşuyolu Heart J 2018;21(2):157-162.
• 13. Sündermann SH, Sromicki J, Biefer HRC, Seifert B, Holubec T, Falk V et al. Mitral valve surgery: right lateral mini thoracotomy or sternotomy? A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2014;148(5):1989-1995.
• 14. Ding C, Wang C, Dong A, Kong M, Jiang D, Tao K et al. Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects: a meta-analysis and systematic review. J Cardiothorac Surg 2012;7:43.
• 15. Lancaster L, Mavroudis C, Rees AH, Slater AD, Ganzel BL, Gray LA. Surgical approach to atrial septal defect in the female. Right thoracotomy versus sternotomy. Am Surg 1990;56(4):218-221.
• 16. Massetti M, Babatasi G, Rossi A, Neri E, Bhoyroo S, Zitouni S et al. Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome. Ann Thorac Surg 1996;62(4):1100-1103.
• 17. Vida VL, Tessari C, Fabozzo A, Padalino MA, Barzon E, Zucchetta F et al. The evolution of the right anterolateral thoracotomy technique for correction of atrial septal defects: cosmetic and functional results in prepubescent patients. Ann Thorac Surg 2013;95(1):242-247.
• 18. Bleiziffer S, Schreiber C, Burgkart R, Regenfelder F, Kostolny M, Libera P et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg 2004;127(5):1474-1480.
• 19. Araco A, Gravante G, Araco P, Gentile P, Castri F, Delogu D et al. Breast asymmetries: a brief review and our experience. Aesthetic Plast Surg 2006;30(3):309-319.
• 20. Schreiber C, Bleiziffer S, Kostolny M, Hörer J, Eicken A, Holper K et al. Minimally invasive midaxillary muscle sparing thoracotomy for atrial septal defect closure in prepubescent patients. Ann Thorac Surg 2005;80(2):673-676.
• 21. Goyal A, Mansel RE. Iatrogenic Injury to the breast bud causing breast hypoplasia. Postgrad Med J 2003;79(930):235-236.
• 22. Dave HH, Comber M, Solinger T, Bettex D, Khatami AD, Pretre R. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg 2009;35(5):864-869.
• 23. Foster CB, Cabrera AG, Bagdure D, Blackwelder W, Moffett BS, Holloway A et al. Characteristics and outcomes of children with congenital heart disease needing diaphragm plication. Cardiol Young 2020;30(1):62-65.
• 24. Altun D, Doğan A, Arnaz A, Yüksek A, Kenanbaş YK, Türköz R et al. Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block. Turk Gogus Kalp Damar Cerrahisi Derg 2020;28(2):257-263.
• 25. Mylonas KS, Ziogas IA, Evangeliou A, Hemmati P, Schizas D, Sfyridis PG et al. Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis. Pediatr Cardiol 2020;41(5):853-861.
• 26. Faccini A, Butera G. Atrial septal defect (ASD) device trans-catheter closure: limitations. J Thorac Dis 2018;10(Suppl 24):S2923-S2930.
• 27. Ohno N, Chaturvedi R, Lee KJ, Benson L. Characteristics of secundum atrial septal defects not percutaneously closed. Catheter Cardiovasc Interv 2015;85(2):234-239.
• 28. Villablanca PA, Briston DA, Cabau JR, Briceno DF, Rao G, Aljoudi M et. Al. Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis. Int J Cardiol 2017;241:149-155.
• 29. Alkashkari W, Albugami S, Hijazi ZM. Current practice in atrial septal defect occlusion in children and adults. Expert Rev Cardiovasc Ther 2020;18(6):315-329.
• 30. Basaran M, Kocailik A, Özbek C, Uçak A, Kafali E, Us M. Comparison of 3 different incisions used for atrial-septal defect closure. Heart Surg Forum 2008;11(5): E290-294.
• 31. Beşir Y, Gökalp O, Karaağaç E, Eygi B, İner H, Yeşilkaya N et al. Mini-thoracotomy versus median sternotomy for atrial septal defect closure: Should mini-thoracotomy be applied as a standard technique? Turk Gogus Kalp Damar Cerrahisi Derg 2019;27(3):280-285.
• 32. Beşoğul Y, Özcan V, Yavuz T, Tünerir B, Aslan R. Açık kalp cerrahisinde minimal invaziv sağ anterolateral minitorakotomi deneyimlerimiz. Anadolu Kardiyol Derg 2002;4:309-312.
• 33. Erentuğ V, Sareyüpoğlu B, Göksedef D, Kırali K, Güler M, İpek G. Closure of atrial septal defects with anterior thoracotomy in female patients. Turk Gogus Kalp Damar Cerrahisi Derg 2005;13:99-102.
• 34. Onan B, Aydin U, Kadirogulları E, Onan İS, Sen O, Kahraman Z. Robotic repair of partial anomalous pulmonary venous connection: the initial experience and technical details. Turk Gogus Kalp Damar Cerrahisi Derg J Robot Surg 2020;14(1):101-107.