Repair of atrial septal defect through a limited right anterolateral thoracotomy in 242 patients: a cosmetic approach?

Background: The repair of atrial septal defects (ASD) is often safely performed as a routine procedure in the young and asymptomatic patient. The purpose of this study is to evaluate the feasibility and especially the cosmetic result of this repair performed through a limited right anterolateral thoracotomy (RALT), with the complete cannulation and aortic cross-clamping conducted through the same incision.

Methods: From January 1980 to June 2001 in our hospital, 242 patients (210 female) with atrial septal defects and a mean age of 26.2 +/- 12.0 years underwent operations through a RALT. Repaired defects included 235 ostium secundum defects and 7 sinus venosus defects with partial anomalous pulmonary venous connection (SV). Patients were contacted by phone to evaluate their satisfaction with the thoracic scar.

Results: There was neither operative nor early mortality. All of the mentioned defects were successfully corrected. Mean bypass times were 12.37 +/- 4.9 minutes for ASD defects and 47.5 +/- 6.4 minutes for SV defects. The mean stay in the intensive care unit was 1.3 +/- 0.5 days. Most of the patients (86.3%) were fully satisfied with the cosmetic result.

Conclusions: The right anterolateral thoracotomy incision provides a safe and effective approach for the correction of the ASD. This approach can be safely performed without any new instruments and without peripheral incisions, provides good exposure for the surgeon to work comfortably, and achieves a cosmetically superior result in selected cases.