title: Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects.
abstract: OBJECTIVE
  We sought to evaluate the safety of a right axillary incision, a cosmetically superior approach than anterolateral thoracotomy, to repair various congenital heart defects.
  
  
  METHODS
  All the patients who were approached with this incision between March 2001 and October 2004 were included in the study. There were 80 patients (median age, 4 years) with atrial septal defect closure (38 patients), repair of partial abnormal pulmonary venous return (14 patients), partial atrioventricular canal (16 patients), and perimembranous ventricular septal defect (12 patients). The surgical technique involved peripheral and central cannulation for institution of cardiopulmonary bypass. Electrically induced ventricular fibrillation was used for defects located in front of the atrioventricular valves, and cardioplegic arrest was used for those located at the level or behind these valves.
  
  
  RESULTS
  The repair was possible without need for conversion to another approach. One patient sustained a transient neurologic deficit. The patients were all in excellent condition after a mean follow-up of 14 months. The cardiac defect was repaired with no residual defect in 75 patients and with trivial residual defect in 5 patients (3 with mitral valve regurgitation, 1 with atrial septal defect, and 1 with ventricular septal defect). The incision healed properly in all, and the thorax showed no deformity.
  
  
  CONCLUSIONS
  The right axillary incision provides a quality of repair for various congenital defects similar to that obtained by using standard surgical approaches. Because it lies more laterally and is hidden by the resting arm, it provides superior cosmetic results compared with conventional incisions, including the anterolateral thoracotomy. Finally, the incision is unlikely to interfere with subsequent development of the breast.
authors.affiliation: Pediatric Cardiac Surgery, Department of Surgery, University Hospital Zurich, Switzerland. rene.pretre@usz.ch
authors.forename: René
authors.initials: R
authors.lastname: Prêtre
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.forename: Hitendu
authors.initials: H
authors.lastname: Dave
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D062109:Dermatologic Surgical Procedures; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D013908:Thoracotomy / Q000379:methods*; D014945:Wound Healing