title: A 5-year experience with surgical repair of atrial septal defect employing limited exposure.
abstract: BACKGROUND
  There has been a trend in recent years towards less invasive therapy for many congenital cardiac malformations. For the past 5 years, we have employed a technique of limited surgical exposure when repairing atrial defects within the oval fossa.
  
  
  METHODS
  Over the 5-year period from July 1992 to August 1997, 115 consecutive patients underwent surgical repair of an isolated atrial septal defect in the region of the oval fossa by a single surgeon. The patients had a limited midline skin incision starting at the line of the nipples and extending inferiorly across 2 to 3 intercostal spaces. A partial sternotomy was performed, sparing the manubrium. Standard instruments and cannulation techniques were used for cardiopulmonary bypass and fibrillatory arrest.
  
  
  RESULTS
  There were no deaths and no major complications. The median time to extubation after leaving the operating room was 3 hours (30 minutes to 8 days). Mediastinal drains were removed the morning after surgery. The median stay in the intensive care unit was 7 hours (3 hours to 10 days), and patients were discharged from the hospital a median of 4 days postoperatively (2 to 23 days).
  
  
  CONCLUSIONS
  This approach using limited exposure can be applied safely without any new instruments and without peripheral incisions or sites of vascular access, while providing a comfortable exposure for the surgeon and achieving a cosmetically superior result for the patient.
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Khan
authors.forename: D B
authors.initials: DB
authors.lastname: McElhinney
authors.forename: V M
authors.initials: VM
authors.lastname: Reddy
authors.forename: F L
authors.initials: FL
authors.lastname: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome