The evolution of the right anterolateral thoracotomy technique for correction of atrial septal defects: cosmetic and functional results in prepubescent patients

Background: The aim of this study was to evaluate the results of a cosmetic right anterolateral thoracotomy (RALT) in prepubescent girls who underwent repair of atrial septal defect (ASD).

Methods: All prepubescent girls who underwent RALT for ASD closure since January 1998 were included. Patient satisfaction with the cosmetic approach and the impact of RALT on breast development were evaluated. One hundred healthy women were used as controls.

Results: One-hundred forty-one patients were included. Median age at repair was 4.6 years (range, 8 months-12 years). The median length of the surgical incision was 9 cm (range 3-20 cm); it was shorter during the last 5 years of our experience (median, 5 cm; range, 3-10 cm; p = 0.001). Fourteen patients (9.9%) experienced a transitory mild sensitive skin deficit in the mammary area, which was associated with the length of the RALT (p = 0.05). At median follow-up of 10.1 years (range, 1.5-14.5 years), 3/60 patients (5%) who had complete breast development had relevant asymmetrical breast development (indexes of breast symmetry > 2 standard deviations of the median value for controls). Six additional patients who underwent RALT (10%) had mild asymmetrical breast development, which was comparable to the control population (p = 0.1). The satisfaction rate for the cosmetic result of RALT was 97.8% (138/141 patients). Reasons for dissatisfaction were the presence of asymmetrical breast development (n = 2) and the presence of a keloid at the incision level (n = 1).

Conclusions: RALT is a reliable surgical technique that combines excellent cosmetic and functional results in almost all patients. With the latest technical refinements, it is our gold standard treatment for ASD in prepubescent girls.