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This article is part of CTSNet’s Guest Editor Series, “Right Axillary Thoracotomy for Repair of a Wide Variety of Congenital Heart Defects in Infants and Children—Should This Be the New Standard?” Guest Editor Dr. Sameh Said has curated a robust collection of content that shares the knowledge, techniques, and insights of several distinguished experts from around the world.
This video presents the authors’ technique for minimal invasive ventricular septal defect closure through a mini right axillary thoracotomy, along with technical tips and pitfalls to avoid, after an experience including hundreds of pediatric patients from 4.5 kg infants to adolescents.
The muscle-sparing right axillary thoracotomy has proven to be safe, reproducible, and teachable for the closure of all perimembranous, inlet, and midmuscular VSDs. It can also be selectively extended to include supracristal defects. Full functional recovery of the right arm and shoulder is fast, with shorter ICU and hospital lengths of stay. The axillary incision is remote from breast tissue and avoids future asymmetric breast growth in females. Superior cosmetic results are achieved with a vertical incision, hidden underneath a resting arm.
This method aims to offer children the loss of their stigma of “having a heart problem” with its negative emotional burden, thereby being able to forget their cardiac defect, which is “curable” with one operation.
References
- Dodge-Khatami A, Salazar JS. Right axillary thoracotomy for transatrial repair of congenital heart defects: VSD, partial AV canal with mitral cleft, PAPVR or Warden, cor triatriatum, and ASD. Oper Techniques Thorac Cardiovasc Surg 2016;20:384-401
- Prêtre R, Kadner A, Dave H, Dodge-Khatami A, Bettex D, Berger F. Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects. J Thorac Cardiovasc Surg. 2005;130:277-81.
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- https://www.ctsnet.org/article/right-axillary-thoracotomy-transatrial-repair-wide-range-congenital-heart-defects
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4 Comments
Excellent video. Very didactic.
Truly an advancement in the management of the young congenital patient.
thank you. i hope it can be useful for your patients.
Thanks for sharing this practical video.
Do you have the follow up of the patients with this detaching tricuspid anterior and septal leaflets regarding long term tricuspid regurgitation?
I have closed poor exposure VSDs with detaching anterior leaflet but in this video you detached both leaflets. Is it safe in long term follow up?
Thanks
Dear Colleague,
thanks for your question and interest. i do not have a systematic follow-up of all patients combined (nearly 500), as many patients were operated on in different countries. However, being in touch with certain groups of cardiologists providing longer term follow-up, i can summarize as follows:
the degree of late tricuspid regurgitation relates more to how successfully you have put it back together at the end of the procedure (ie. your intra-operative saline flush test, the post-operative TEE result, and even TTE at hospital discharge), rather than how much annular length or how many leaflets you detach.
even if you unhinge most of the annulus but reconstruct it perfectly, it will hold in the long term – even if a small portion is detached but incorrectly reconstructed, it will remain, ie. iatrogenic TI : it really is worth taking the extra time (during ischemia or on a beating heart, as appropriate) to attempt perfect reconstruction acheiving coaptation at the first index VSD closure operation, so there is minimal TI; i often even use 7-0 Prolene in infants to tyr to get it as right as posssible.
i hope this helps.