title: Strictly-posterior thoracotomy: a minimal-access approach for construction of the modified Blalock-Taussig shunt in West African children.
abstract: BACKGROUND
  In resource-poor settings, the modified Blalock-Taussig shunt (MBTS) is often performed for symptomatic relief of Fallot's tetralogy. From September 2011, we adopted the strictly posterior thoracotomy (SPOT), a minimal-access technique for the MBTS and report the cosmetic advantages in this communication.
  
  
  METHODS
  We retrospectively analyzed the records of consecutive patients in whom the SPOT approach was used to construct the MBTS. Study end-points were early mortality, improvement in peripheral oxygenation, morbidity, and the cosmetic appeal.
  
  
  RESULTS
  Between September 2011 and January 2013, 15 males and 8 females, median age 4 years (1.3 - 17 years) and weight 13 kg (11 - 54 kg) underwent the MBTS through the SPOT approach. The polytetrafluoroethylene grafts used ranged from sizes 4 - 6mm (median 5mm). The median preoperative SpO2 was 74% (55% - 78%), increasing to a postoperative median value of 84% (80% - 92%). Shunts were right-sided in 22 patients and left-sided in one. There were no shunt failures. Hospital stay ranged from 7 - 10 days. There was one early death (4.3%), and two postoperative complications (re-exploration for bleeding and readmission for drainage of pleural effusion). The surgical scars had excellent cosmetic appeal: they ranged from 5-10 cm in length; all were entirely posterior and imperceptible to the patient.
  
  
  CONCLUSIONS
  The SPOT approach represents a safe and cosmetically superior alternative to the standard posterolateral thoracotomy, the scar being imperceptible to the patient. The excellent cosmetic appeal and preservation of body image makes this approach particularly attractive in children and young adults.
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Frank
authors.initials: F
authors.lastname: Edwin
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Baffoe
authors.initials: B
authors.lastname: Gyan
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Innocent
authors.initials: I
authors.lastname: Adzamli
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Mark
authors.initials: M
authors.lastname: Tettey
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Kow
authors.initials: K
authors.lastname: Entsua-Mensah
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Martin
authors.initials: M
authors.lastname: Tamatey
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Sereboe
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Aniteye
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P O Box KB 846, Accra, Ghana.
authors.forename: Nana
authors.initials: N
authors.lastname: Akyaa-Yao
mesh_terms: D000293:Adolescent; D000354:Africa, Western / Q000453:epidemiology; D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000191:economics / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000453:epidemiology / Q000601:surgery; D013908:Thoracotomy / Q000379:methods* / Q000706:statistics & numerical data
keywords: Congenital heart disease; minimal-access surgery; modified Blalock-Taussig shunt; polytetrafluoroethylene; tetralogy of Fallot; thoracotomy