Mustafa PAÇ, Serhat KOCA, Tuğba AVCI, Ayşenur PAÇ, Ahmet Kuddusi İRDEM, Denizhan BAĞRUL, Ardit COLLAKU, Irfan TAŞOĞLU

Sağ minitorakotomi ile atriyal septal defekt kapatılması: Tek merkez deneyimimiz

Amaç: Bu yazıda santral kanülasyon ve sağ minitorakotomi ile atriyal septal defekt tamiri deneyimimiz sunuldu. Çalışma planı: Ocak 2013 - Haziran 2016 tarihleri arasında, toplam 148 hastada (93 kadın, 55 erkek; ort. yaş 15.7 yıl; dağılım 1.5-50 yıl) atriyal septal defektler sağ minitorakotomi ile kapatıldı. Sağ minitorakotomi insizyon yerine hastaların yaşı ve cinsiyetine göre karar verildi. Tüm hastalarda santral aortik ve bikaval kanülasyon uygulandı. Cilt insizyonu 13 yaş altı çocuklarda 5±1 cm, 13 yaş üstü çocuklarda 6±1.5 cm ve yetişkinlerde 7.5 cm uzunluğunda idi. Atriyal septal defektler tüm hastalarda sağ minitorakotomi ile başarıyla kapatıldı (3 triküspid yetmezliği, 17 parsiyel anormal pulmoner venöz dönüş anomalisi ve 2 Scimitar sendromu). Bulgular: Hiçbir hastada mortalite izlenmedi. Ameliyat sırasında acil sternotomi veya femoral kanülasyon ihtiyacı olmadı. Ortalama kardiyopulmoner baypas süresi 38±8.2 dk. iken, ortalama aortik kros-klemp süresi 16±3.8 dk. ve ortalama ameliyat süresi 124±11.3 dk. idi. Ortalama yoğun bakımda kalış süresi 22 saat ve hastane kalış süresi 4 ila 6 gün idi. Dört hastada (%3.25) ekokardiyografide hemodinamik olarak hemodinamik açıdan önemsiz rezidüel atriyal septal defekt saptandı. Sonuç: Atriyal septal defektlerin düzeltilmesinde submammaryan insizyon ile birlikte sağ minitorakotominin iyi estetik sonuçlar ile birlikte güvenli ve etkili bir teknik olduğu düşünülmektedir.

Atrial septal defect closure via right mini-thoracotomy: Our single center experience

Background: In this article, we report our experience with repair of atrial septal defects through central cannulation and a right mini-thoracotomy.Methods: A total of 148 patients (93 females, 55 males; mean age 15.7 years; range 1.5 to 50 years) underwent atrial septal defect closure via right mini-thoracotomy between January 2013 and June 2016. Right mini-thoracotomy incision localization was determined according to patients’ age and gender. Central aortic and bicaval cannulation was performed in all the patients. The mean length of the skin incision was 5±1 cm in the patients under 13 years of age and 6±1.5 cm in the patients over 13 years of age and 7.5 cm in adolescents. Atrial septal defects were successfully closed through a right mini-thoracotomy in all patients (3 tricuspid regurgitation, 17 partial anomalous pulmonary venous connection, and, 2 Scimitar syndrome).Results: Mortality was seen in none of the patients. No intraoperative urgent sternotomy or femoral cannulation was required. The mean cardiopulmonary bypass time was 38±8.2 min, while the mean aortic cross-clamp time was 16±3.8 min and the mean time of surgery was 124±11.3 min. The mean intensive care unit stay was 22 hours and duration of hospital stay was 4 to 6 days. Hemodynamically non-significant residual atrial septal defects were detected on echocardiography in four patients (3.25%).Conclusion: We consider that right mini-thoracotomy with submammary skin incision for the correction of atrial septal defects is a safe and effective technique with improved cosmetic results.

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