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Experiences in surgical closure of atrial septal defect with anterior mini-thoracotomy approach.

Baharestani B, Rezaei S, Jalili Shahdashti F, Omrani G, Heidarali M - J Cardiovasc Thorac Res (2014)

Bottom Line: One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients.In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Introduction: Anterior mini-thoracotomy approach is a good alternative to median sternotomy in Atrial Septal Defect (ASD) repair. Our purpose is to explain the details of our technique and peresent the results.

Methods: Seventy five patients with ASD (52 female and 23 male) were operated with anterior mini-thoracotomy approach in our tertiary center between March 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes were defined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time, morbidity, mortality, the size of incision, the amount of post-operative bleeding, need for blood transfusion and reoperation.

Results: Mean Cardiopulmonary bypass time was 49.62 minutes (26 to 105 minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (11 to 47 minutes). The mean amount of blood transfusion was 47.49± 62.22 mm (0 to 200 cc) and the mean chest tube drainage after surgery was 80.17 ±121.06 mm (0 to 600 cc). One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.

Conclusion: Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.

No MeSH data available.


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Mentions: Myocardial protection would be achieved with ante grade cardioplegic solution infusion through an angiocath at the ascending aorta, then right atrium opene and stay sutures are used for better exposure. After examination of both mitral and tricuspid valves we can repair the defect with pericardial patch. In first cases, we closed ASD directly but because we had a case with detachment of ASD closure in suture lines, now we almost always use a pericardial patch for the closure of ASD. After de-airing of left atrium from the last suture, atrium closure and de-airing of ascending aorta from the insertion point of cardioplegia and de-clamping of Aorta, we can close this point with a simple stitch. After discontinuation of CPB, de-cannulation, administration of protamine, hemostasis, and chest tube insertion, the incision can be closed in 4 layers’ of soft tissue and sub-coetaneous stitches for skin closure (Figure 2). We did not use rib stitches in this group patients because it results in more post-operative pain.


Experiences in surgical closure of atrial septal defect with anterior mini-thoracotomy approach.

Baharestani B, Rezaei S, Jalili Shahdashti F, Omrani G, Heidarali M - J Cardiovasc Thorac Res (2014)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195969&req=5

Mentions: Myocardial protection would be achieved with ante grade cardioplegic solution infusion through an angiocath at the ascending aorta, then right atrium opene and stay sutures are used for better exposure. After examination of both mitral and tricuspid valves we can repair the defect with pericardial patch. In first cases, we closed ASD directly but because we had a case with detachment of ASD closure in suture lines, now we almost always use a pericardial patch for the closure of ASD. After de-airing of left atrium from the last suture, atrium closure and de-airing of ascending aorta from the insertion point of cardioplegia and de-clamping of Aorta, we can close this point with a simple stitch. After discontinuation of CPB, de-cannulation, administration of protamine, hemostasis, and chest tube insertion, the incision can be closed in 4 layers’ of soft tissue and sub-coetaneous stitches for skin closure (Figure 2). We did not use rib stitches in this group patients because it results in more post-operative pain.

Bottom Line: One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients.In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Introduction: Anterior mini-thoracotomy approach is a good alternative to median sternotomy in Atrial Septal Defect (ASD) repair. Our purpose is to explain the details of our technique and peresent the results.

Methods: Seventy five patients with ASD (52 female and 23 male) were operated with anterior mini-thoracotomy approach in our tertiary center between March 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes were defined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time, morbidity, mortality, the size of incision, the amount of post-operative bleeding, need for blood transfusion and reoperation.

Results: Mean Cardiopulmonary bypass time was 49.62 minutes (26 to 105 minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (11 to 47 minutes). The mean amount of blood transfusion was 47.49± 62.22 mm (0 to 200 cc) and the mean chest tube drainage after surgery was 80.17 ±121.06 mm (0 to 600 cc). One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.

Conclusion: Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.

No MeSH data available.


Related in: MedlinePlus