The Use of Minimally Invasive Surgical Techniques in Pediatric Patients with Partial Anomalous Pulmonary Venous Return
Öz
Aim: The use of minimally invasive procedures in low-risk congenital heart surgeries has been increasing recently. Compared to traditional median sternotomy, minimally invasive techniques offer better cosmetic results and provide more satisfaction to both the patient and their parents. Partial anomalous pulmonary venous return (PAPVR) can be safely repaired using these techniques.
Material and Metods: The perioperative data of right- sided PAPVR patients who were operated on using minimally invasive approaches in our clinic between March 2019 and January 2023 were reviewed retrospectively. The perioperative data of the patients' including , type of surgery , cardiopulmonary bypass time, cross-clamp time, postoperative cardiac rhythm, total operation time, total drainage, total intensive care unit time, and total hospital stay time were obtained. The results were compared with the data in the current literature.
Results: During the study period, 14 patients underwent surgical repair. Five (36%) of them were female and nine (64%) were male. Patients undergoing right infraaxillary vertical thoracotomy (RIAVT) and right anterolateral thoracotomy (RALT) had mean ages of 48±26.6 and 42±18.2 month, respectively. High venosum type atrial septal defect (ASD) was detected in 12 (85.7%) of the patients. The most frequently used surgical treatment was the double patch technique which was used in 12 patients (85.7%). This was followed by single patch repair with one patient (7.1 %). The Warden procedure was used in one patient (7.1%) who was operated on with the RIAVT technique. Patients’ cross-clamp, cardiopulmonary bypass (CPB), and total operation times were comparable to those reported in the medical literature.
Conclusion: RIAVT and RALT are two of the oftenly used minimally invasive surgical techniques in congenital heart surgery. After gaining sufficient experience, both of these methods can be safely applied to PAPVR repair.
Anahtar Kelimeler
Anomalous pulmonary venous return, pediatrics, minimally invasive surgical procedure, thoracotomy
Kaynakça
- Healey Jr JE. An anatomic survey of anomalous pulmonary veins: their clinical significance. J Thorac Surg 1952;23: 433-44.
- Alsoufi B, Cai S, Van Arsdell GS, Williams WG, Caldarone CA, Coles JG. Outcomes after surgical treatment of children with partial anomalous pulmonary venous connection. Ann Thorac Surg 2007; 84 :2020-6.
- Gustafson RA, Warden HE, Murray GF. Partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg 1995;60: 614-617.
- Senocak F, Ozme S, Bilgiç A, Ozkutlu S, Ozer S, Saraçlar M. Partial anomalous pulmonary venous return. Evaluation of 51 cases. Jpn Heart J 1994;35: 43-50.
- Ammash NM, Seward JB, Warnes CA, Connolly HM, O’Leary PW, Danielson GK. Partial anomalous pulmonary venous connection: diagnosis by transesophageal echocardiography. J Am Coll Cardiol 1997;29: 1351-8.
- An K, Li S, Yan J, Wang X, Hua Z. Minimal right vertical infra-axillary incision for repair of congenital heart defects. Ann Thorac Surg 2022;113: 896-902.
- Rao RK, Varadaraju R, Basappa G, Nagaraja P. Repair of sinus venosus defects with partial anomalous pulmonary venous connection in children by modified right vertical infra axillary thoracotomy. Innovations 2019;14: 553-7.
- Zubritskiy A, Arkhipov A, Khapaev T, Naberukhin Y, Omelchenko A, Gorbatykh Y, et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg 2016;22: 225-7.
- Kasahara H, Aeba R, Tanami Y, Yozu R. Multislice computed tomography is useful for evaluating partial anomalous pulmonary venous connection. J Cardiothorac Surg 2010;5: 1-3.
- Amirghofran AA, Nirooei E, Edraki M, Ramsheh AR, Ajami G, Amoozgar H, et al. Minimally invasive versus sternotomy approach for double‐patch repair of partial anomalous pulmonary venous connection and sinus venosus defect in pediatric and adult patients: Mid to long‐term outcomes. J Thorac Surg 2022;37:4808-15.