Kadner Alexander, Dodge-Khatami Ali, Dave Hitendu, Knirsch Walter, Bettex Dominique, Prêtre René
Division of Congenital Cardiac Surgery, Children's Hospital, University of Zurich, Zurich, Switzerland.
Heart Surg Forum. 2006;9(6):E836-9. doi: 10.1532/HSF98.20061064.
To report the midterm results of an alternative minimally invasive approach for closure of ventricular septal defects (VSD) through a muscle-sparing minithoracotomy at the right midaxillary line.
From September 2003 to December 2005, 22 patients (median age, 5 years; range, 1.5-12 years) underwent a right lateral axillary thoracotomy for closure of a perimembranous VSD. Special features of the approach included an incision between the anterior and posterior axillary fold, a muscle-sparing preparation over the fourth intercostal space, and the establishment of cardiopulmonary bypass with inguinal and superior vena cava cannulation. The ascending aorta was cross clamped and cardioplegic arrest was instituted. The VSDs were all approached through a right atriotomy and closed directly (17 patients) or with a patch (5 patients). Three patients underwent concomitant aortic valve repair.
There was no mortality or significant surgical morbidity. Median cross-clamp and cardiopulmonary bypass times were 46 and 104 min, respectively. Follow-up was complete and ranged from 2 to 22 months (median, 20 months). All patients were in sinus rhythm. Echocardiography revealed no residual defects with competent aortic and tricuspid valves. The length of the incision ranged from 4 to 6 cm, was away from the mammary gland, and remained entirely covered by the adducted arm. All children recovered right shoulder function within days, and cosmetic results were very satisfying. One patient developed iliac artery stenosis following inguinal artery cannulation.
Closure of perimembranous VSDs in older children can be safely performed through a right axillary thoracotomy without compromising the accuracy of the repair. The cosmetic results are excellent.
报告一种通过右腋中线保留肌肉的小切口开胸术来闭合室间隔缺损（VSD）的替代性微创方法的中期结果。
2003年9月至2005年12月，22例患者（中位年龄5岁；范围1.5 - 12岁）接受了右侧腋下开胸术以闭合膜周部VSD。该方法的特点包括在腋前襞和腋后襞之间做切口，在第四肋间间隙进行保留肌肉的操作，以及通过腹股沟和上腔静脉插管建立体外循环。升主动脉被交叉钳夹并实施心脏停搏。所有VSD均通过右心房切开术进入并直接闭合（17例患者）或用补片闭合（5例患者）。3例患者同时进行了主动脉瓣修复。
无死亡病例或严重手术并发症。中位交叉钳夹时间和体外循环时间分别为46分钟和104分钟。随访完整，时间范围为2至22个月（中位时间20个月）。所有患者均为窦性心律。超声心动图显示无残余缺损，主动脉瓣和三尖瓣功能正常。切口长度为4至6厘米，远离乳腺，完全被内收的手臂覆盖。所有儿童在数天内恢复了右肩部功能，美容效果非常令人满意。1例患者在腹股沟动脉插管后发生髂动脉狭窄。
大龄儿童膜周部VSD的闭合可通过右腋下开胸术安全进行且不影响修复的准确性。美容效果极佳。
