Garg Pankaj, Bishnoi Arvind Kumar, Lakhia Ketav, Surti Jigar, Siddiqui Sumbul, Solanki Parth, Pandya Himani
Department of Cardiovascular and Thoracic Surgery of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India.
Department of Cardiac Anesthesia of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India.
Braz J Cardiovasc Surg. 2017 May-Jun;32(3):184-190. doi: 10.21470/1678-9741-2016-0041.
: Perventricular device closure of ventricular septal defect through midline sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic advantage. Perventricular device closure of ventricular septal defect with transverse split sternotomy was performed to add the cosmetic advantage of mini-invasive technique.
: Thirty-six pediatric patients with mean age 7.14±3.24 months and weight 5.00±0.88 kg were operated for perventricular device closure of ventricular septal defect through transverse split sternotomy in 4th intercostal space under transesophageal echocardiography guidance. In case of failure or complication, surgical closure of ventricular septal defect was performed through the same incision with cervical cannulation of common carotid artery and internal jugular vein for commencement of cardiopulmonary bypass. All the patients were postoperatively followed, and then discharged from hospital due to their surgical outcome, morbidity and mortality.
: Procedure was successful in 35 patients. Two patients developed transient heart block. Surgical closure of ventricular septal defect was required in one patient. Mean duration of ventilation was 11.83±3.63 hours. Mean intensive care unit and hospital stay were 1.88±0.74 days and 6.58±1.38 days, respectively. There was no in-hospital mortality. A patient died one day after hospital discharge due to arrhythmia. No patients developed wound related, vascular or neurological complication. In a mean follow-up period of 23.3±18.45 months, all 35 patients were doing well without residual defect with regression of pulmonary artery hypertension as seen on transthoracic echocardiography.
: Transverse split sternotomy incision is a safe and effective alternative to a median sternotomy for perventricular device closure of ventricular septal defect with combined advantage of better cosmetic outcomes and avoidance of cardiopulmonary bypass.
经胸骨正中切口行室间隔缺损经心室装置封堵术可避免体外循环，但缺乏美容优势。采用经胸骨横断劈开切口行室间隔缺损经心室装置封堵术以增加微创技术的美容优势。
36例平均年龄7.14±3.24个月、体重5.00±0.88kg的儿科患者，在经食管超声心动图引导下，于第4肋间行胸骨横断劈开切口，行室间隔缺损经心室装置封堵术。若手术失败或出现并发症，则通过同一切口行室间隔缺损外科修补术，同时经颈总动脉和颈内静脉插管开始体外循环。所有患者术后均进行随访，然后根据手术结果、发病率和死亡率出院。
35例手术成功。2例患者出现短暂性心脏传导阻滞。1例患者需要行室间隔缺损外科修补术。平均通气时间为11.83±3.63小时。平均重症监护病房停留时间和住院时间分别为1.88±0.74天和6.58±1.38天。无院内死亡。1例患者出院后1天因心律失常死亡。无患者出现与伤口、血管或神经相关的并发症。在平均23.3±18.45个月的随访期内，所有35例患者情况良好，无残余缺损，经胸超声心动图显示肺动脉高压消退。
胸骨横断劈开切口是经心室装置封堵室间隔缺损的胸骨正中切口的一种安全有效的替代方法，具有更好的美容效果和避免体外循环的综合优势。
