title: Ventricular septal defects closure using a minimal right vertical infraaxillary thoracotomy: seven-year experience in 274 patients.
abstract: BACKGROUND
  From December 2001 to February 2008, right vertical infraaxillary thoracotomy (RVIAT) was used to perform ventricular septal defect (VSD) closure in selected patients. This retrospective study reviews our results and experiences.
  
  
  METHODS
  The study included 274 patients (143 females, 131 males) undergoing VSD closure through a RVIAT approach. Patients were a mean age of 10.5 +/- 8.9 years (range, 0.5 to 43 years). Body weight was 37.8 +/- 12.5 kg (range, 8 to 72 kg). The VSD was subpulmonary in 14 patients and perimembranous in 260.
  
  
  RESULTS
  No perioperative or late deaths occurred during the follow-up. Cardiac defects were corrected in all patients through RVIAT. The mean incision length was 7.2 +/- 2.9 cm (range, 4.1 to 8.9 cm). Cardiopulmonary bypass time was 61.6 +/- 27.8 minutes (range, 29 to 187 minutes), and aortic clamp time was 33.4 +/- 20.8 minutes (range, 5 to 139 minutes). The mean postoperative hospital stay was 4.9 +/- 2.6 days (range, 2 to 14 days). Postoperative echocardiograms revealed 3 patients with residual shunt with later catheter intervention. The cosmetic advantage of the RVIAT is the short incision under the armpit that is often invisible. All patients were satisfied with the cosmetic results during the follow-up.
  
  
  CONCLUSIONS
  The RVIAT can be performed with favorable cosmetic and clinical results for VSD closure. It provides a good alternative to standard median sternotomy for VSD patients.
authors.affiliation: Department of Thoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.forename: Qingguo
authors.initials: Q
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wu
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhou
authors.forename: Dong-jin
authors.initials: DJ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015897:Comorbidity; D004452:Echocardiography; D004954:Esthetics; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques; D013908:Thoracotomy / Q000379:methods*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult