Surgical Maneuver for Ventricular Septal Defect Exposure During Congenital Heart Surgery Through the Right Axillary Transverse Minithoracotomy

医学 胸骨正中切开术 纤维接头 外科 体外循环 三尖瓣 肋间间隙 开胸手术 心脏病学
作者
Oleksandr Babliak,Volodymyr Demianenko,Dmytro Babliak,Anton Marchenko
出处
期刊:Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery [SAGE]
卷期号:17 (5): 438-441
标识
DOI:10.1177/15569845221129347
摘要

Right axillary transverse minithoracotomy is not conventionally used for ventricular septal defect (VSD) repair because of complicated VSD exposure and the need for a temporary tricuspid valve leaflet detachment to facilitate VSD exposure. Recently, our team developed a new, not previously described surgical maneuver that markedly facilitates perimembranous VSD exposure without any need for tricuspid valve leaflet detachment. The above-mentioned VSD exposure maneuver was used in 21 patients with a median age of 5 months (range, 1.5 to 132 months) and a median body weight of 7 kg (range, 4 to 47 kg). The length of the incision varied from 3 to 4.5 cm over the fourth intercostal space within the anterior and posterior axillary lines. Central cardiopulmonary bypass cannulation and antegrade blood cardioplegia were performed in all patients. Bent/angled instruments were used throughout the procedure to facilitate the surgeon's view. Pericardial sutures and suspension of tricuspid valve chords were used as general exposure maneuvers. A special surgical maneuver aimed at changing the general plane of the ventricular septum was used. It consisted of one intraventricular exposing suture. Sufficient exposure of perimembranous VSD was obtained in all patients and was comparable with what is usually obtained through the median sternotomy. With the use of this new maneuver, all perimembranous VSDs could be safely exposed and repaired with the conventional suturing technique through the right axillary transverse minithoracotomy starting from 2 months of age.
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