Surgery for the right vertical infra-axillary thoracotomy in treatment of outlet ventricular septal defect in children

Background

Outlet ventricular septal defect is often associated with aortic valve regurgitation. Early intervention in these subjects is essential to avoid complications of irreversible aortic valve regurgitation after surgery.

Objective

This study aims to evaluate the safety and feasibility of right vertical infra-axillary thoracotomy for the treatment of outlet ventricular septal defect in pediatric patients.

Methods

This report includes data from 39 pediatric patients who underwent right vertical infra-axillary thoracotomy from January 2020 to April 2023. The ventricular septal defect was approached via the pulmonary artery and closed using autologous or bovine pericardium. Intraoperative management of associated lesions included tricuspid valve repair, widening of the right ventricular outflow tract with excision of jet lesions, and ligation of the ductus arteriosus.

Results

The average weight of the pediatric patients was 8.4 ± 6 kg, with the average age at intervention being 17.1 months. Approximately 50 % of the patients exhibited signs of heart failure preoperatively, and in 38.5 % of cases, the defect was located beneath the two great arteries. The mean durations for extracorporeal circulation and cardioplegia were 113.5 ± 22 min and 70.3 ± 17 min, respectively. There were no postoperative deaths, and no patient required conversion to an alternative surgical approach. The average duration of mechanical ventilation was 17.6 ± 20.7 h, and the postoperative hospital stay averaged 6.8 ± 2.2 days. Follow-up was conducted in all patients, with an average duration of 17.4 months. There was one case of mild residual shunt, one case requiring re-intervention for aortic valve regurgitation, and one case of elevated shoulder blade due to damage to the long thoracic nerve. No instances of mammary asymmetry were observed.

Conclusion

Right vertical infra-axillary thoracotomy is a safe and feasible alternative for the treatment of outlet ventricular septal defect in children. Further studies across multiple centers are recommended to assess the efficacy of this approach.