Minimal Invasive Right Axillary Thoracotomy for Ventricular Septal Defect Closure: Tips and Pitfalls

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

1. 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
2. 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.
3. https://youtube/ihnfQGiVDsY
4. https://www.ctsnet.org/article/right-axillary-thoracotomy-transatrial-repair-wide-range-congenital-heart-defects

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