Right anterolateral mini-thoracotomy without inferior vena cava cannulation for atrial septal defect repair in small children: A feasible technique

Objective: To evaluate the effectiveness and safety of right anterolateral mini-thoracotomy without inferior vena cava (IVC) cannulation for closing atrial septal defect (ASD) in small children.

Methods: From February 2016 to August 2017, 10 patients (the mean age was 18.5 ± 10.1 months and the mean weight was 8.3 ± 2.1 kg) underwent ASD closure via right anterolateral mini-thoracotomy. The superior vena cava cannula was placed through the right internal jugular vein. A 3-4 cm incision was made on the right chest. The pleural and pericardial cavities were filled with CO₂ and the heart was beating during the surgery. Blood returned from IVC was drained by a right heart sucker. All ASDs were closed using artificial patch, continuous suture. Mean follow-up was 18 months (range, 15-22 months).

Results: No post-operative complications or deaths occurred. Mean operation time and mean cardiopulmonary bypass time were 140.5 ± 27.8 min and 50.3 ± 16.5 min, respectively. These patients were extubated within the first 6 h. The intensive care unit stay time and the post-operative hospital stay time were 19.6 ± 2.6 h and 7.1 ± 1.2 days, respectively. Follow-up transthoracic echocardiography showed no residual shunts or lung atelectasis.

Conclusions: The right anterolateral mini-thoracotomy without IVC cannulation is feasible for repairing ASD in small children. This technique is effective and safe and can be used as a therapeutic option for ASD.