Atrial Septal Defect Closure in the Setting of Severe Pectus Excavatum: A Unique Case

The authors present a case of a fenestrated atrial septal defect (ASD) closure in a 6-year-old female child with severe pectus excavatum and pulmonary hypertension, performed via vertical right axillary thoracotomy. 

A 6-centimeter vertical skin incision was made in the right mid axillary line extending from the second to the fourth intercostal spaces, and the chest entered via the third intercostal space. This video demonstrates how challenging the visualization was due to the severe pectus deformity, including for aortic and venous cannulations, cardiotomy and subsequent visualization of the ASD. A 0.4-millimeter Gore-Tex patch was used to close the ASD. A right axillary thoracotomy can be a viable option for complex congenital heart defects in the setting of severe chest wall abnormalities, and careful planning is needed for optimal exposure. 

References

1. Said SM, Greathouse KC, McCarthy CM, Brown N, Kumar S, Salem MI, Kloesel B, Sainathan S. Safety and Efficacy of Right Axillary Thoracotomy for Repair of Congenital Heart Defects in Children. World J Pediatr Congenit Heart Surg. 2023 Jan;14(1):47-54. doi: 10.1177/21501351221127283. PMID: 36847761.

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