Pushing Boundaries in Pediatric Cardiac Surgery: Minimally Invasive Bidirectional Glenn Via Vertical Right Axillary Thoracotomy

An 8-month-old boy with a functional single ventricle secondary to double outlet right ventricle with severe pulmonary stenosis and hypoplastic left ventricle was deemed unsuitable for biventricular repair at this stage. Due to progressive cyanosis, he was offered a bidirectional cavopulmonary anastomosis (bidirectional Glenn), and because of the lack of previous surgical interventions, it was felt that he could be a candidate for a minimally invasive approach. 

The procedure was performed through a vertical right axillary thoracotomy (VRAT) and under normothermic cardiopulmonary bypass with a beating heart. The superior vena cava (SVC) was divided, and the cardiac end was oversewn. The azygous vein was doubly ligated and divided. The cephalic end of the SVC was then connected in an end-to-side fashion to the superior border of the right pulmonary artery. 

The postoperative course was uneventful, and he was extubated in the operating room and discharged five days later. He continued to do well during his follow-ups. 

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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