Right axillary minithoracotomy: An alternative access to close an ASD

2021 ◽  
Keyword(s):  
Heart Defects ◽  
Median Sternotomy ◽  
Long Term Results ◽  
Special Equipment ◽  
Vertical Incision ◽  
Midaxillary Line ◽  
Muscle Sparing ◽  
The Right ◽  
Midline Sternotomy

A vertical right axillary thoracotomy is a favorable alternative to a median sternotomy for surgical correction of common congenital heart defects in patients of all ages. The right-sided heart structures can be approached through a 4- to 5-cm vertical incision in the midaxillary line. In contrast to a midline sternotomy, osseous thoracic structures can be preserved through a muscle-sparing approach simply by retracting the ribs. Consequently, recovery is usually faster, and the resulting scar is completely hidden under the resting arm. In addition, there is no need for special equipment. The entire operation can be performed with established techniques. Operative outcome and long-term results have been shown by several research groups to be comparable to those obtained with a median sternotomy. This tutorial demonstrates the stepwise performance of an axillary thoracotomy and the extracorporeal circulation setup by the example of the closure of an atrial septal defect.

scholarly journals Characterization of morphology and function of the ‘neo-atria’ after a modified Mustard operation

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Mohamed Nagy ◽  
Hatem Hosny ◽  
Amr El Sawy ◽  
Ahmed Mahgoub ◽  
Magdi H Yacoub
Keyword(s):  
Contractile Function ◽  
Postoperative Recovery ◽  
Long Term Results ◽  
3D Segmentation ◽  
Mustard Operation ◽  
The Right ◽  
And Function ◽  
Atrial Systole

Background: There is a pressing need to improve early and long-term results of the Mustard operation. A modification of the operation was introduced at the Aswan Heart Centre for this purpose which relies on creating new functional atria rather than the two rigid channels in the classical Mustard operation.Objectives: To evaluate the morphology and function of the neo-atria, shortly after modified mustard operation for a ‘neglected’ patient with TGA, VSD and severe pulmonary hypertension.Methods: A 6-year-old with neglected TGA, VSD and pulmonary hypertension presented with severe cyanosis, clubbing and haemoconcentration (Hb 22 g/dL), underwent the modified Aswan-Mustard operation (MAM) with rapid smooth postoperative recovery. Repeated 2D echograms and multi-slice CT scans, followed by 3D segmentation, were performed after the operation. The size, shape, and morphology of the neo-atria were measured and measurements of the patterns of instantaneous filling and emptying of the right and left ventricles were quantified.Results: The neo-systemic venous atrium consisted of three components with a combined volume of 78 mL/m2, all of which contributed to the reservoir, conduit, and importantly contractile function of the neo-atrium. The pulmonary venous atrium consisted of two components with a combined volume of 66 mL/m2. These measurements were made at atrial end diastole. The volumes of the systemic venous and the pulmonary venous diminished to 51 and 54 mL/m2, respectively, at the end atrial systole - indicating relatively preserved contractile functions.

Long-Term Results of Flap Reconstruction in Median Sternotomy Wound Infections

1994 ◽  
Vol 93 (6) ◽  
pp. 1208-1214 ◽  
Author(s):  
Paul R. Ringelman ◽  
Craig A. Vander Kolk ◽  
Duke Cameron ◽  
William A. Baumgartner ◽  
Paul N. Manson
Keyword(s):  
Median Sternotomy ◽  
Long Term Results ◽  
Wound Infections ◽  
Flap Reconstruction

Zenker's Diverticulotomy with the Carbon Dioxide Laser: Perioperative Management and Long-Term Results

2003 ◽  
Vol 112 (3) ◽  
pp. 202-205 ◽  
Author(s):  
Markus Hoffmann ◽  
Heinrich H. Rudert ◽  
David Scheunemann ◽  
Steffen Maune
Keyword(s):  
Carbon Dioxide Laser ◽  
Perioperative Management ◽  
Treatment Strategies ◽  
Functional Results ◽  
Long Term Results ◽  
Special Equipment ◽  
Laser Systems ◽  
Zenker’S Diverticulotomy ◽  
Low Rate

We analyzed 119 files of patients with Zenker's diverticulum who were treated with CO2 laser systems concerning treatment management, complications, and long-term results. Although the tissue bridge was dissected down to the fundus of the diverticulum, opening the mediastinum, mediastinitis was observed in none of the cases. Of the patients followed up for long-term results, 90.3% were completely symptom-free, and 5.8% of the patients reported an improvement in general condition. In view of the low rate of complications and the low level of morbidity and because of the good functional results, microendoscopic laser surgical diverticulotomy can be recommended as suitable therapy, especially as compared to external approaches or even other endoscopic treatment strategies. The main advantage as compared to staple-assisted esophagodiverticulostomy is that no special equipment is needed and that even small pouches can be treated successfully.

Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

2019 ◽  
Vol 29 (8) ◽  
pp. 1036-1039
Author(s):  
Yoichi Kawahira ◽  
Kyoichi Nishigaki ◽  
Koji Kagisaki ◽  
Takuji Watanabe ◽  
Kazuki Tanimoto
Keyword(s):  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Systolic Pressure ◽  
Cardiac Repair ◽  
Long Term Results ◽  
Arterial Oxygen ◽  
The Right

AbstractBackground:In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.Methods:Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.Results:There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.Conclusion:Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

Catheter Ablation Approach on the Right Side Only for Paroxysmal Atrial Fibrillation Therapy: Long-Term Results

2000 ◽  
Vol 23 (2) ◽  
pp. 224-233 ◽  
Author(s):  
ANDREA NATALE ◽  
FABIO LEONELLI ◽  
SALWA BEHEIRY ◽  
KEITH NEWBY ◽  
ENNIO PISANO ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Paroxysmal Atrial Fibrillation ◽  
Long Term Results ◽  
The Right
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