title: Minimally invasive repair of atrial septal defects.
abstract: BACKGROUND
  Minimally invasive pediatric cardiac surgical techniques continue to evolve and remain challenged by technologic advances in percutaneous devices developed to treat congenital heart disease exclusive of cardiopulmonary bypass. Public tenacity for "incisionless" operations, however, must remain balanced scrupulously against the collective safety of the surgical procedure.
  
  
  METHODS
  Twenty-three pediatric patients underwent repair of atrial septal defects through a partial sternal split and a limited skin incision (5 to 7 cm) at our institution between July 1995 and October 1996.
  
  
  RESULTS
  The average age of the patients was 6 years and 2 months (range, 19 months to 15 years) and the average weight was 23.3 kg (range, 11.3 to 61.7 kg). The average bypass time was 35 minutes (range, 19 to 81 minutes). Fourteen patients had a single dose of blood cardioplegia administered, whereas 9 had ventricular fibrillation electrically induced. Twenty-two patients had ostium secundum defects and 1 had a sinus venosus defect. The average length of the hospital stay was 3.6 days (range, 3 to 6 days). There were no operative or late deaths.
  
  
  CONCLUSIONS
  Modifications of this technique continue to evolve as an effective cosmetic alternative to submammary and thoracotomy approaches. Advantages of this modification include excellent cosmetic results in all age groups and the concomitant security and familiarity of mediastinal access and full sternotomy when required.
authors.affiliation: Division of Cardiovascular Surgery, The Hospital for Sick Children and The University of Toronto, Ontario, Canada. michael.black@mailhub.sickkids.on.ca
authors.forename: M D
authors.initials: MD
authors.lastname: Black
authors.forename: R M
authors.initials: RM
authors.lastname: Freedom
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006324:Heart Arrest, Induced; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013997:Time Factors