Li Qianzhen, Chen Xiaodong, Xu Weiye, Chen Liangwan
Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, Fujian, P. R. China.
Fujian Key Laboratory of Vascular, Aging(Fujian Medical University), Fuzhou, Fujian, P. R. China.
J Cardiothorac Surg. 2025 Feb 24;20(1):142. doi: 10.1186/s13019-025-03355-4.
Full median sternotomy is the traditional approach for the treatment of left ventricular aneurysms (LVA) with or without concomitant ventricular septal rupture (VSR). However, it has some disadvantages such as reduced breathing and exercise thoracic stability, which may increase the surgical risk for older or fragile patients. Herein, we report a case of successful minimally invasive bilateral thoracotomy.
A 79-year-old male patient visited our center complaining of breathlessness and orthopnea 21 days after an acute myocardial infarction and percutaneous coronary intervention. An LVA (34.7 mm × 44.4 mm) and a VSR with a diameter of 10 mm close to the apex was detected by echocardiography. Bilateral thoracotomy was performed via two incisions: a 3 cm incision at the right 3rd intercostal space for the aortic root and left atrium vent cannula and aortic clamping; a 7 cm incision at the left 5th intercostal space to expose the apex for LVA and VSR repair. The patient was discharged 7 days postoperatively without any complications.
LVA with or without VSR can be successfully repaired via bilateral thoracotomy with promising outcomes.
全胸骨正中切开术是治疗伴或不伴室间隔破裂（VSR）的左心室室壁瘤（LVA）的传统方法。然而，它存在一些缺点，如呼吸功能下降和胸廓运动稳定性降低，这可能会增加老年或体弱患者的手术风险。在此，我们报告一例成功的微创双侧开胸手术病例。
一名79岁男性患者在急性心肌梗死和经皮冠状动脉介入治疗21天后因呼吸困难和端坐呼吸前来我院就诊。超声心动图检查发现一个大小为34.7mm×44.4mm的左心室室壁瘤以及一个靠近心尖、直径为10mm的室间隔破裂。通过两个切口进行双侧开胸手术：在右第3肋间做一个3cm的切口，用于插入主动脉根部和左心房的腔静脉插管以及进行主动脉阻断；在左第5肋间做一个7cm的切口，用于暴露心尖以修复左心室室壁瘤和室间隔破裂。患者术后7天出院，无任何并发症。
伴或不伴室间隔破裂的左心室室壁瘤均可通过双侧开胸手术成功修复，效果良好。
