title: [Minimally invasive cardiac surgelry for congenital heart diseases].
abstract: We have performed 174 pediatric open-heart operations using a lower midline skin incision and a minimal sternotomy approach since 1996. There was no death or major complication caused by this approach, and the resulting scar in each patient is difficult to be seen under an ordinary undershirt. The technique of a lower mid-line skin incision and minimal sternotomy approach is a safe, reliable and cosmetically advantageous method for a pediatric cardiac operation. We have applied an autologous blood predonation protocol in pediatric open-heart surgery since 1996. The study included 103 children weighing 7.5 kg or more. 8 ml/kg of blood was taken twice before operation. 97 patients (94.2%) needed no homologous blood transfusion during cardiopulmonary bypass. We consider our protocol of autologous blood predonation to be safe and effective for avoiding homologous blood transfusion in pediatric patients. Twelve children with patent ductus arteriosus (PDA) were successfully treated by thoracoscopic surgery under transesophageal echocardiography, by which interruption of the ductal flow was confirmed. Video-assisted endoscopic surgery can be safely applied to pediatric patients with PDA. This technique may be an effective addition to the staged management of more complex forms of congenital heart defects. To minimize deleterious postoperative influences of cardiopulmonary bypass on the pulmonary circulation, the right heart bypass operation was achieved without use of cardiopulmonary bypass. Four patients in whom no intracardiac procedure was needed, have undergone this operative maneuver using a temporary bypass. This operative procedure is especially recommended for pulmonary atresia with intact ventricular septum with sinusoidal communication when decompression of right ventricular pressure might cause coronary steel and ischemia.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Okamura
mesh_terms: D000293:Adolescent; D001804:Blood Transfusion, Autologous; D002648:Child; D002675:Child, Preschool; D047549:Coronary Artery Bypass, Off-Pump; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013906:Thoracoscopy