title: Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy.
abstract: To investigate the feasibility and cosmetic results of a right subaxillary thoracotomy for closure of doubly committed subarterial ventricular septal defects.
  
  
  
  From October 2009 to September 2015, 78 patients [50 boys, 28 girls, mean age 4.7 ± 2.9 years (range, 0.5-15 years) and mean body weight 16.3 ± 9.6 kg (range, 7-42 kg)] with doubly committed subarterial ventricular septal defects were treated with minimally invasive surgical closure through a right subaxillary thoracotomy. All procedures were performed through an oblique 5- to 8-cm subaxillary mini-incision and the fourth intercostal space. The defect was approached through the main pulmonary artery or the right ventricular outflow tract. The defect was closed with a piece of Dacron patch or directly with one to two pledgetted polypropylene sutures. Additional procedures involved closure of atrial septal defects, closure of patent foramen ovale, mitral annuloplasty, tricuspid annuloplasty and relief of right ventricular outflow tract obstruction.
  
  
  
  The median cardiopulmonary bypass and aortic cross-clamp times were 51 ± 26.5 (33-78) and 27 ± 13.6 (15-46) min, respectively. The incision length was 6.7 ± 1.5 cm (range, 5.0-8.0 cm). The follow-up period was 37 ± 27.5 months (range, 6-72 months). The cardiac defect was repaired with a trivial to mild residual defect in 3 patients (2 patients with a small residual shunt and 1 with mild mitral regurgitation). No chest deformity or asymmetrical development of the breast was found.
  
  
  
  A right subaxillary thoracotomy, providing a feasible alternative to median sternotomy, can be performed with favourable cosmetic and satisfactory clinical results for closure of doubly committed subarterial ventricular septal defects.
authors: Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China.|Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
authors: Guoying
authors: G
authors: An
authors: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
authors: Hongyu
authors: H
authors: Zhang
authors: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
authors: Shanguang
authors: S
authors: Zheng
authors: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
authors: Weixin
authors: W
authors: Wang
authors: Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China.
authors: Qin
authors: Q
authors: Wu
authors: Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China xingqs0532@163.com.
authors: Quansheng
authors: Q
authors: Xing
mesh_terms: D000293:Adolescent; D001365:Axilla; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*
keywords: Doubly committed subarterial; Minimally invasive cardiac surgery; Right subaxillary thoracotomy; Ventricular septal defect