The 60th Annual Meeting of Japanese Society of Pediatric Cardiology and Cardiac Surgery

Presentation information

JCK-AP session

Surgery

JCK-AP session 6-2 (III-JCKAP6-2)
Surgery 2

Sat. Jul 13, 2024 8:30 AM - 9:20 AM ROOM 8・JCK-AP Forum (5F 502+503)

Chair:Shingo Kasahara(Department of Cardiovascular Surgery,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
Chair:Chang Ha Lee(Sejong General Hospital)

[III-JCKAP6-2-4] Peri-Areolar Approach for Minimally Invasive Closure of Type 1 Ventricular Septal Defect

Eung Re Kim, Chang-Ha Lee, Jae Hong Lim, Yong-Jin Kim, Hyun Chung, Jung Yoon Kim (Sejong General Hospital, Bucheon)

Keywords:Minimally invasive cardiac surgery, type 1 ventricular septal defect, peri-areolar incision

Objective: Type 1 or outlet ventricular septal defects(VSD) are challenging to visualize through a right thoracotomy, and many centers still use sternotomy for repair. We present a minimally invasive approach combining a peri-areolar incision and left anterior thoracotomy for repairing type 1 VSD in adult patients.
Methods: In a supine position, a three-centimeter incision is made along the cranio-medial border of the left areolar. The subcutaneous fat layer is carefully dissected towards the second intercostal space. Access to the pericardial space can be achieved through a mini-thoracotomy at the second intercostal space. Cardiopulmonary bypass is initiated via peripheral cannulation, and the aorta is clamped with a Chitwood clamp introduced through a separate port in the axillary area. After the heart is stopped, an incision at the main pulmonary artery provides a clear view of the right ventricle outflow tract(RVOT) and the VSD.
Results: Three female and one male patients underwent minimally invasive VSD closure at a median age of 31 years [range 18-56]. Cardiopulmonary bypass and aorta cross-clamp time were at a median of 129 [range 114-170] and 69 [range 54-151] minutes, respectively. Everyone was extubated the same day and discharged after a median of 4 days [range 4-7].
Conclusion: A minimally invasive approach combining a peri-areolar incision and left anterior thoracotomy provides fast recovery and superior cosmetic results for the repair of type 1 VSDs or simple RVOT procedures in adult patients.