TECHNIQUES AND EARLY RESULTS OF MINI LEFT THORACOTOMY APPROACH FOR REPAIR OF TETRALOGY OF FALLOT
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 18
Abstract
BACKGROUND Right minithoracotomy and lower partial sternotomy are usual approaches for mini-invasive repair of congenital cardiac defects with a better cosmetic outcome. These approaches have been inadequate for repair of TOF due to limited exposure of the Right Ventricular Outflow Tract (RVOT) and pulmonary artery. Mini-left thoracotomy approach is sternal sparing and has the advantages of a cosmetic mini incision for surgical correction of patients with Tetralogy of Fallot (TOF). MATERIALS AND METHODS From December 2013 and January 2015, 27 paediatric patients (15 females) with mean age 13.2 years and mean weight 26.7 kg underwent intracardiac repair for TOF. A mini-left thoracotomy in third intercostal space involving a 3-5cm skin incision was used in all the patients. In 12 patients, pulmonary annulus was preserved and infundibular muscle resection was performed through RVOT. Fifteen patients received transannular patch. Ventricular Septal Defect (VSD) was closed through right ventriculotomy in all the patients. RESULTS There was no mortality or significant morbidity in the postoperative period or during follow up. Mean cross-clamp time was 48.33 minutes and mean cardiopulmonary bypass time was 83.66 minutes. All patients were weaned off mechanical ventilation within 14 hours of surgery. There was no residual defect in any patient. All patients were in NYHA class I during follow-up. During follow-up, one patient (preserved annulus) had residual gradient of 40 mmHg across right ventricular outflow tract without symptoms. CONCLUSION The left minithoracotomy is a safe and effective alternative to a classical median sternotomy in selected group of patients for surgical repair of TOF with satisfactory results and better cosmesis.
Authors and Affiliations
Chirag Doshi, Vivek Wadhawa, Manish Hinduja, Pankaj Garg, Nikunj Vaidhya, Jaydip Ramani, Vaibhav Jain, Mausam Shah
Keywords
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- EP ID EP215017
- DOI 10.18410/jebmh/2017/199
- Views 184
- Downloads 1
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