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Wadle M, Joffe D, Backer C, Ross F. Perioperative and Anesthetic Considerations in Vascular Rings and Slings. Semin Cardiothorac Vasc Anesth 2024; 28:152-164. [PMID: 38379198 DOI: 10.1177/10892532241234404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.
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Affiliation(s)
| | | | - Carl Backer
- Kentucky Children's Hospital Congenital Heart Clinic, Lexington, KY, USA
| | - Faith Ross
- Seattle Children's Hospital, Seattle, WA, USA
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2
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Pollak U, Feinstein Y, Mannarino CN, McBride ME, Mendonca M, Keizman E, Mishaly D, van Leeuwen G, Roeleveld PP, Koers L, Klugman D. The horizon of pediatric cardiac critical care. Front Pediatr 2022; 10:863868. [PMID: 36186624 PMCID: PMC9523119 DOI: 10.3389/fped.2022.863868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Pediatric Cardiac Critical Care (PCCC) is a challenging discipline where decisions require a high degree of preparation and clinical expertise. In the modern era, outcomes of neonates and children with congenital heart defects have dramatically improved, largely by transformative technologies and an expanding collection of pharmacotherapies. Exponential advances in science and technology are occurring at a breathtaking rate, and applying these advances to the PCCC patient is essential to further advancing the science and practice of the field. In this article, we identified and elaborate on seven key elements within the PCCC that will pave the way for the future.
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Affiliation(s)
- Uri Pollak
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Feinstein
- Pediatric Intensive Care Unit, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Candace N Mannarino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Mary E McBride
- Divisions of Cardiology and Critical Care Medicine, Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Malaika Mendonca
- Pediatric Intensive Care Unit, Children's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | - Grace van Leeuwen
- Pediatric Cardiac Intensive Care Unit, Sidra Medicine, Ar-Rayyan, Qatar.,Department of Pediatrics, Weill Cornell Medicine, Ar-Rayyan, Qatar
| | - Peter P Roeleveld
- Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Lena Koers
- Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Darren Klugman
- Pediatrics Cardiac Critical Care Unit, Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins Medicine, Baltimore, MD, United States
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3
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Vernamonti J, Gadepalli SK. Non-cardiac surgical considerations in pediatric patients with congenital heart disease. Semin Pediatr Surg 2021; 30:151036. [PMID: 33992307 DOI: 10.1016/j.sempedsurg.2021.151036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jack Vernamonti
- Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Samir K Gadepalli
- Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA.
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Development of patient specific, realistic, and reusable video assisted thoracoscopic surgery simulator using 3D printing and pediatric computed tomography images. Sci Rep 2021; 11:6191. [PMID: 33737647 PMCID: PMC7973538 DOI: 10.1038/s41598-021-85738-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/24/2021] [Indexed: 11/19/2022] Open
Abstract
Herein, realistic and reusable phantoms for simulation of pediatric lung video-assisted thoracoscopic surgery (VATS) were proposed and evaluated. 3D-printed phantoms for VATS were designed based on chest computed tomography (CT) data of a pediatric patient with esophageal atresia and tracheoesophageal fistula. Models reflecting the patient-specific structure were fabricated based on the CT images. Appropriate reusable design, realistic mechanical properties with various material types, and 3D printers (fused deposition modeling (FDM) and PolyJet printers) were used to represent the realistic anatomical structures. As a result, the phantom printed by PolyJet reflected closer mechanical properties than those of the FDM phantom. Accuracies (mean difference ± 95 confidence interval) of phantoms by FDM and PolyJet were 0.53 ± 0.46 and 0.98 ± 0.55 mm, respectively. Phantoms were used by surgeons for VATS training, which is considered more reflective of the clinical situation than the conventional simulation phantom. In conclusion, the patient-specific, realistic, and reusable VATS phantom provides a better understanding the complex anatomical structure of a patient and could be used as an educational phantom for esophageal structure replacement in VATS.
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Alsarraj MK, Nellis JR, Vekstein AM, Andersen ND, Turek JW. Borrowing from Adult Cardiac Surgeons-Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 15:101-105. [PMID: 32352905 DOI: 10.1177/1556984520911020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.
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Affiliation(s)
- Mohammed K Alsarraj
- 367854 Central Michigan University College of Medicine, Mount Pleasant, MI, USA.,22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Joseph R Nellis
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA
| | - Andrew M Vekstein
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
| | - Nicholas D Andersen
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
| | - Joseph W Turek
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
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Herrin MA, Zurakowski D, Fynn-Thompson F, Baird CW, del Nido PJ, Emani SM. Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults. J Thorac Cardiovasc Surg 2017; 154:607-615. [DOI: 10.1016/j.jtcvs.2017.01.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/29/2016] [Accepted: 01/28/2017] [Indexed: 11/24/2022]
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González-López MT, Pérez-Caballero-Martínez R, Pita-Fernández AM, de-Agustín-Asensio JC, Gil-Jaurena JM. Programa de aprendizaje con modelos animales para corrección videoasistida de cardiopatías congénitas en edad pediátrica: primeros pasos en España. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Backer CL, Rigsby CK. Vascular rings: To scope or not to scope. J Thorac Cardiovasc Surg 2017; 154:616-617. [PMID: 28412114 DOI: 10.1016/j.jtcvs.2017.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Cynthia K Rigsby
- Division of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Kirali K, Güler M, Dağlar B, Ipek G, Balkanay M, Akinci E, Berki T, Gürbüz A, Işik Ö, Yakut C. Videothoracoscopic Internal Mammary Artery Harvest for Coronary Bypass. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239900700402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Between March 1996 and September 1997, videothoracoscopy was performed in 50 of 140 patients who underwent minimally invasive coronary artery bypass grafting. Mean age was 45.3 ± 6.8 years. The left internal mammary artery was harvested by thoracoscopy alone in 21 patients and by both thoracoscopy and direct vision in 29. Coronary artery bypass was then performed through a left anterior minithoracotomy. In 48 patients, the internal mammary artery was grafted directly to the left anterior descending artery; a small saphenous vein graft was interposed in the other 2 patients. The diagonal branch was bypassed with saphenous vein in 2 patients, the first obtuse marginal in 1, the right posterior descending branch in 1, and the right ventricular branch of the right coronary artery in 1. Concomitant carotid endarterectomy was performed in 1 patient. There was no mortality. Two patients had perioperative myocardial infarction. It was concluded that videothoracoscopy can help to achieve complete mobilization of the left internal mammary artery for minimally invasive coronary artery bypass grafting. These techniques can be regarded as safe and effective, giving excellent results and a shortened hospital stay with the advantage of avoiding some morbidity due to costal cartilage resection.
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Affiliation(s)
- Kaan Kirali
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Mustafa Güler
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Bahadir Dağlar
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Gökhan Ipek
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Mehmet Balkanay
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Esat Akinci
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Turan Berki
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Ali Gürbüz
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Ömer Işik
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Cevat Yakut
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
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Abstract
The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. In the current era, the diagnosis of a vascular ring is best established by CT imaging that can accurately delineate the anatomy of the vascular ring and associated tracheal pathology. For patients with a right aortic arch there recently has been an increased recognition of a structure called a Kommerell diverticulum which may require resection and transfer of the left subclavian artery to the left carotid artery. A very rare vascular ring is the circumflex aorta that is now treated with the aortic uncrossing operation. Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time.
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Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrada R Popescu
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Osama M Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey C Rastatter
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Bang JH, Kim SH, Park CS, Park JJ, Yun TJ. Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease. J Thorac Cardiovasc Surg 2015; 150:490-5. [DOI: 10.1016/j.jtcvs.2015.06.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/15/2015] [Accepted: 06/21/2015] [Indexed: 11/25/2022]
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Lee JH, Yang JH, Jun TG. Video-assisted thoracoscopic division of vascular rings. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:78-81. [PMID: 25705605 PMCID: PMC4333858 DOI: 10.5090/kjtcs.2015.48.1.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/07/2014] [Accepted: 10/27/2014] [Indexed: 12/05/2022]
Abstract
This study reports our early experience with thoracoscopic division of vascular rings. Three patients were reviewed; their ages at surgery were 25 months, 4 years, and 57 years. All patients were suffering from complete vascular rings involving combinations of the right aortic arch, left ligamentum arteriosum, Kommerell’s diverticulum, and retroesophageal left subclavian artery. The median surgical time was 180.5 minutes, and the patients showed immediate recovery. Three complications, namely chylothorax, transient supraventricular tachycardia, and left vocal cord palsy, were observed. Our early experience indicates that thoracoscopic division of a vascular ring may provide early recovery and could be a promising operative choice.
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Affiliation(s)
- Jung Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Nezafati MH, Nezafati P. Video assisted thoracoscopic surgery cases with right-sided aortic arch aneurysm and complete vascular ring: Case report. Int J Surg Case Rep 2014; 6C:188-90. [PMID: 25544489 PMCID: PMC4334953 DOI: 10.1016/j.ijscr.2014.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 11/30/2022] Open
Abstract
Think of vascular ring when facing an infant with vomiting after feeding, stridor, high pitched and brassy cough, noisy respiration, emesis and respiratory distress. Use of CT angiography, MRI and barium swallow to evaluate vascular ring and its type. Video assisted thoracoscopic surgery (VATS) is a feasible procedure for sectioning the right-sided aortic arch by the use of clips.
Introduction Right-sided aortic arch with aberrant left subclavian artery and ligamentum arteriosum, after double aortic arch, is the second most common complete vascular ring. It was traditionally treated by open surgical thoracotomy and recently video assisted thoracoscopic surgery (VATS) has been used in some cases. Presentation of case We describe the cases of two infants who presented with gastroesophageal reflux, dyspnea, dysphagia secondary to aneurysmal dilatation of the retroesophageal arch confirmed by imaging data. VATS procedure was performed through a left thoracoscopic approach. Ligamentum arteriosus compressed esophagus was clipped, sectioned and then released the esophagus in one case; also, In the second case, we clipped and sectioned aorta, distal to the origin of aberrant left subclavian artery. Discussion CT angiography and MRI are known to be the most effective available imaging methods for vascular ring detection. Also, there are several surgical approaches to vascular rings such as, thoracotomy and thoracoscopy. There is a large body of evidence confirming the safety, efficacy and convenience of VATS as a therapeutic option for congenital heart disease including right-sided aortic arch and aberrant left subclavian artery. Conclusion VATS is a less invasive and safe strategy for management of right-sided aortic arch with aberrant left subclavian artery and ligamentum arteriosum.
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Affiliation(s)
| | - Pouya Nezafati
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
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Cao H, Chen Q, Li QZ, Chen LW, Zhang GC, Chen DZ, Qiu ZH, Hu YN, He JJ. A clinical study of thoracoscopy-assisted mitral valve replacement concomitant with tricuspid valvuloplasty, with domestically manufactured pipeline products for cardiopulmonary bypass. J Cardiothorac Surg 2014; 9:160. [PMID: 25274144 PMCID: PMC4192743 DOI: 10.1186/s13019-014-0160-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/23/2014] [Indexed: 11/28/2022] Open
Abstract
Objective To discuss the feasibility and experience of treating valvular heart diseases with thoracoscopy-assisted mitral valve replacement concomitant with tricuspid valvuloplasty, with domestically manufactured pipeline products for cardiopulmonary bypass. Methods A total of 135 patients with valvular heart disease were admitted to our hospital between January 2011 and January 2013. They received thoracoscopy-assisted mitral valve replacement concomitant with tricuspid valvuloplasty, with domestically manufactured pipeline products. A cardiopulmonary bypass with domestically-manufactured pipeline products was established during the surgery. The procedure was accomplished with the assistance of thoracoscopy through a small incision in the right chest wall. Results All 135 patients underwent a successful surgery, and were followed up for the duration of half a year to two years. None of them displayed any evidence of complications. Our procedure had the advantage of fewer complications and a significantly shortened time period for the patient care and hospitalization. As opposed to imported pipeline products for cardiopulmonary bypass, our procedure had the advantage of similar clinical results at a lower cost. Conclusions Thoracoscopy-assisted mitral valve replacement concomitant with tricuspid valvuloplasty was proved to be a safe and effective method for cardiopulmonary bypass, with the use of domestically manufactured pipeline products. Electronic supplementary material The online version of this article (doi:10.1186/s13019-014-0160-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Fuzhou 350001, P, R, China.
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15
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Torok RD, Wei B, Kanter RJ, Jaquiss RDB, Lodge AJ. Thoracoscopic resection of the left atrial appendage after failed focal atrial tachycardia ablation. Ann Thorac Surg 2014; 97:1322-7. [PMID: 24462413 DOI: 10.1016/j.athoracsur.2013.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/30/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This case series describes 3 patients with the unusual location of focal atrial tachycardia in the left atrial appendage who failed catheter ablation but were successfully treated by left atrial appendage resection by a totally thoracoscopic surgical technique. METHODS In all 3 cases, left atrial appendage resection was carried out by video-assisted thoracoscopic surgery using only 3 5- to 10-mm incisions, eliminating the need for median sternotomy or thoracotomy. An endoscopic stapler was used to resect the left atrial appendage at its base, successfully eliminating the source of the patients' focal atrial tachycardia. RESULTS The mean operative time was 84 minutes. All 3 patients tolerated the procedure without any complications and were discharged on postoperative day 3. At an average follow-up of 4.5 years, all patients remained asymptomatic and with normal ambulatory rhythm monitoring off all antiarrhythmic medications. CONCLUSIONS Surgical resection of the left atrial appendage using a totally thoracoscopic approach is a safe and successful treatment option for patients who have failed endocardial catheter ablation. This novel approach utilizes smaller incisions and shorter operative times than the more invasive surgical techniques previously described in the literature.
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Affiliation(s)
- Rachel D Torok
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Benjamin Wei
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ronald J Kanter
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Robert D B Jaquiss
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Andrew J Lodge
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic Da Vinci surgical system. J Cardiothorac Surg 2013; 8:119. [PMID: 23634811 PMCID: PMC3652753 DOI: 10.1186/1749-8090-8-119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 04/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More and more surgeons and patients focus on the minimally invasive surgical techniques in the 21st century. Totally thoracoscopic operation provides another minimal invasive surgical option for patients with ASD (atrial septal defect). In this study, we reported our experience of 61 patients with atrial septal defect who underwent totally thoracoscopic operation and discussed the feasibility and safety of the new technique. METHODS From January 2010 to October 2012, 61 patients with atrial septal defect underwent totally thoracoscopic closure but not traditional median sternotomy surgery. We divided the 61 patients into two groups based on the operation sequence. The data of group A (the first 30 cases) and group B (the last 31 cases). The mean age of the patients was 35.1 ± 12.8 years (range, 6.3 to 63.5 years), and mean weight was 52.7 ± 11.9 kg (range, 30.5 to 80 kg). Mean size of the atrial septal defect was 16.8 ± 11.3 mm (range, 13 to 39 mm) based on the description of the echocardiography. RESULTS All patients underwent totally thoracoscopy successfully, 36 patients with pericardium patch and 25 patients were sutured directly. 7 patients underwent concomitant tricuspid valvuloplasty with Key technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 68.5 ± 19.1 min (range, 31.0 to 153.0 min), the mean time of aortic cross-clamp was 27.2 ± 11.3 min (range, 0.0 to 80.0 min) and the mean time of operation was 149.8 ± 35.7 min (range, 63.0 to 300.0 min). Postoperative mechanical ventilation averaged 4.9 ± 2.5 hours (range, 3.5 to 12.6 hours), and the duration of intensive care unit stay 20.0 ± 4.8 hours (range, 15.5 to 25 hours). The mean volume of blood drainage was 158 ± 38 ml (range, 51 to 800 ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at 3-month follow-up. CONCLUSION The totally thoracoscopic operation is feasible and safe for patients with ASD, even with or without tricuspid regurgitation. This technique provides another minimal invasive surgical option for patients with atrial septal defect.
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Liu G, Qiao Y, Zou C, Ma L, Ni L, Zeng S, Li X, Cheng Q. Totally thoracoscopic surgical treatment for atrial septal defect: mid-term follow-up results in 45 consecutive patients. Heart Lung Circ 2012; 22:88-91. [PMID: 23122742 DOI: 10.1016/j.hlc.2012.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/19/2012] [Accepted: 09/25/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Totally thoracoscopic operation provides minimally invasive alternative for patients with atrial septal defect. In this study, we report the mid-term follow-up results of 45 patients with atrial septal defect who underwent totally thoracoscopic operation and discuss the feasibility and safety of this new technique. METHODS From January 2010 to February 2012, 45 patients with atrial septal defect underwent totally thoracoscopic closure as an alternative to traditional median sternotomy surgery. The mean age of the patients was 33.2±12.5 years (range 6.3-61.5 years), and mean weight was 55.7±11.1 kg (range 30.5-80 kg). Based on echocardiography the mean size of the atrial septal defect was 16.0±10.8mm (range 13-39 mm). RESULTS All patients underwent totally thoracoscopic repair. Twenty-five patients with a pericardial patch and 20 patients were sutured directly. Five patients underwent concomitant tricuspid valvuloplasty with Kay technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 70.5±20.6 min (range 31.0-153.0 min), the mean time of aortic cross-clamp was 28.8±13.3 min (range 0.0-80.0 min) and the mean time of operation was 155.8±36.8 min (range 65.0-300.0 min). Postoperative mechanical ventilation averaged 5.1±2.8h (range 3.6-12.6h), and the duration of intensive care unit stay 20.0±5.6h (range 16.2-25 h). The mean volume of blood drainage was 156±36 ml (range 51-800 ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at three-month follow-up. CONCLUSION Totally thoracoscopic repair is feasible and safe for patients with ASD, even with or without tricuspid regurgitation however more clinical data is needed in the future study.
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Affiliation(s)
- Gaoli Liu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, 324#, Jingwu Road, Jinan, 250012, PR China; Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China.
| | - Yanli Qiao
- Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, 324#, Jingwu Road, Jinan, 250012, PR China
| | - Liming Ma
- Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China
| | - Liangchun Ni
- Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China
| | - Shanguang Zeng
- Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China
| | - Xiang Li
- Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China
| | - Qianjin Cheng
- Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical University, PR China
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Nezafati MH, Soltani G, Mottaghi H, Horri M, Nezafati P. Video-assisted thoracoscopic patent ductus arteriosus closure in 2,000 patients. Asian Cardiovasc Thorac Ann 2012; 19:393-8. [PMID: 22160407 DOI: 10.1177/0218492311424782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Video-assisted thoracoscopic surgery has proved to be a safe and effective method with low complication and high success rates. From 1997 to 2008, 2,000 consecutive patients with patent ductus arteriosus underwent closure of the ductus with 2 titanium clips via a video-assisted thoracoscopic technique. Complete closure was confirmed using our handmade intraesophageal stethoscope. The mean age was 5.2 years, and mean weight was 9.8 kg. One death was reported 1 month after surgery, due to sepsis during hospitalization for chylothorax treatment. The procedure was converted to an emergency thoracotomy in one case, due to ductal wall rupture. There were 4 late residual shunts treated via thoracotomy. We observed transient laryngeal nerve dysfunction in 14 patients. All patients were reassessed by postoperative echocardiography. The mean procedure (skin-to-skin) time was 10 ± 2 min, and hospitalization was 21 h. This study indicates that video-assisted thoracoscopic closure of patent ductus arteriosus is a safe, simple, and cost-effective method with low complication and high success rates. Furthermore, the cosmetic benefits make it appropriate as an out-patient procedure.
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Affiliation(s)
- Mohammad Hassan Nezafati
- Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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Abstract
OBJECTIVES To perform surgical closure of a clinically significant arterial duct on children in a third world country. BACKGROUND An arterial duct is one of the most common congenital cardiac defects. Large arterial ducts can cause significant pulmonary overcirculation, causing symptoms of congestive cardiac failure, ultimately resulting in premature death. Closure of an arterial duct is usually curative, allowing for a normal quality of life and expectancy. In western countries, arterial duct closure in children is usually performed by deployment of a device through a catheter-based approach, replacing previous surgical approaches. In third world countries, there is limited access to the necessary resources for performing catheter-based closure of an arterial duct. Consequently, children with an arterial duct in a third world country may only receive palliative care, can be markedly symptomatic, and often do not survive to adulthood. METHODS We assembled a team of 11 healthcare workers with extensive experience in the medical and surgical management of children with congenital cardiac disease. In all, 21 patients with a history of an arterial duct were screened by performing a comprehensive history, physical, and echocardiogram at the Angkor Hospital for Children in Siem Reap, Cambodia. RESULTS A total of 18 children (eight male and ten female), ranging in age from 10 months to 14 years, were deemed suitable to undergo surgery. All patients were symptomatic, and the arterial ducts ranged in size from 4 to 15 millimetres. Surgical closure was performed using two clips, and in four cases with the largest arterial duct, sutures were also placed. All patients had successful closure without any significant complications, and were able to be discharged home within 2 days of surgery. Of note, four children with arterial ducts died in the 5 months before our arrival. CONCLUSION Surgical closure of an arterial duct can be performed safely and effectively by an experienced paediatric cardiothoracic surgical team on children in a third world country. We hope that our experience will inspire others to perform similar missions throughout the world.
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Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, Wells WJ. Thoracic Duct Ligation for Persistent Chylothorax After Pediatric Cardiothoracic Surgery. Ann Thorac Surg 2009; 88:246-51; discussion 251-2. [DOI: 10.1016/j.athoracsur.2009.03.083] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/26/2009] [Accepted: 03/27/2009] [Indexed: 01/30/2023]
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Durkin EF, Shaaban A. Commonly encountered surgical problems in the fetus and neonate. Pediatr Clin North Am 2009; 56:647-69, Table of Contents. [PMID: 19501697 DOI: 10.1016/j.pcl.2009.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neonatal surgical care requires a current understanding of pre- and postnatal intervention for a myriad of congenital anomalies. This article includes an update of the recent information on commonly encountered fetal and neonatal surgical problems, highlighting specific areas of controversy and challenges in diagnosis. The authors hope that this article is useful for trainees and practitioners involved in any aspect of fetal and neonatal care.
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Affiliation(s)
- Emily F Durkin
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, H4/325 Clinical Science Center, Madison, WI 53798, USA
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22
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del Nido PJ. Minimal incision congenital cardiac surgery. Semin Thorac Cardiovasc Surg 2008; 19:319-24. [PMID: 18395631 DOI: 10.1053/j.semtcvs.2007.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2007] [Indexed: 11/11/2022]
Abstract
Minimally invasive techniques have had limited application in congenital cardiac surgery, primarily due to the complexity of the defects, small working area, and the fact that most defects require exposure to intracardiac structures. Advances in cannula design and instrumentation have allowed application of minimal incision techniques but in most cases, cardiopulmonary bypass is still required. Image guided surgery, which uses noninvasive imaging to guide intracardiac procedures, holds the promise of permitting performance of reconstructive surgery in the beating heart in children.
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Affiliation(s)
- Pedro J del Nido
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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23
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Gaca AM, Jaggers JJ, Dudley LT, Bisset GS. Repair of Congenital Heart Disease: A Primer—Part 2. Radiology 2008; 248:44-60. [DOI: 10.1148/radiol.2481070166] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Darbari A, Chandra G, Gupta A, Kumar A, Bharadwaj M, Tandon S. Clinical outcomes and experiences with trans-axillary surgical ligation of patent ductus arteriosus. Indian J Thorac Cardiovasc Surg 2007. [DOI: 10.1007/s12055-007-0037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Abstract
Persistent patency of the arterial duct represents one of the most common lesions in the field of congenital cardiac disease. The strategies for management continue to evolve. In this review, we focus on management beyond the neonatal period. We review the temporal evolution of strategies for management, illustrate the currently available the techniques for permanent closure of the patent arterial duct, review the expected outcomes after closure, discuss the current controversy over the appropriate treatment of the so-called "silent" duct, and provide recommendations for the current state of management of patients with persistent patency of the arterial duct outside of the neonatal period.At the Congenital Heart Institute of Florida, we now recommend closure of all patent arterial ducts, regardless of their size. Before selecting and performing the type of procedure, we explain the natural history of the persistently patent arterial duct to the parents or legal guardian of the child. Particular emphasis is placed on the risks of endocarditis, including the recognition that many cases of endocarditis may not be preventable. The devastating effects of endocarditis, coupled with the perception of more anecdotal reports of endocarditis with the silent duct, as well as the low risk of interventions, has led us to recommend closure of the patent arterial duct in these situations. We now recommend intervention, after informed consent, for all patients with a patent arterial duct regardless of size, including those in which the patent duct is "silent". We recognize, however, that this remains a controversial topic, especially given the new recommendations for endocarditis prophylaxis from American Heart Association. Since 2003, our strategy for closure of the patent arterial duct has changed subsequent to the availability of the Amplatzer occluder. This new device has allowed significantly larger patent arterial ducts to be closed with interventional catheterization procedures that in the past would have been closed at surgery. During the interval between 2002 and 2006 inclusive, the overall surgical volume at our Institute has been stable. Over this period, the number of patients undergoing surgical ligation of the patent arterial duct has decreased, with this decline in volume most notable for the subgroup of patients weighing more than five kilograms. This decrease has been especially notable in thoracoscopic procedures and is attributable to the increased ability to close larger ducts using the Amplatzer occluder. For infants with symptomatic pulmonary overcirculation weighing less than 5 kilograms, our preference is for the surgical approach. For patients who have ductal calcification, significant pleural scarring, or "window-like" arterial ducts, video-assisted ligation is not an option and open surgical techniques are used. When video-assisted ligation is possible, the approach is based on family and surgeon preference. When open thoracotomy is selected, we usually use a muscle-sparing left posterolateral thoracotomy. For patients weighing more than 5 kilograms, we currently recommend percutaneous closure for all patent arterial ducts as the first intervention, reserving surgical treatment for those cases that are not amenable to the percutaneous approach. For symptomatic infants weighing greater than 5 kilogram with large ducts, we prefer to use the Amplatzer occluder. In rare instances, the size of the required ductal occluder is so large that either encroachment into the aorta or pulmonary arteries is noted, and the device is removed. The child is then referred for surgical closure. We can now often predict via echocardiography that a duct is too large for transcatheter closure, even with the Amplatzer occluder, and refer these patients directly to surgery. For patients with an asymptomatic patent arterial duct, we prefer to wait until the weight is from 10 to 12 kilograms, or they are closer to 2 years of age. If the patent arterial duct is greater than 2.0 to 2.5 millimetres in diameter, our preference is to use the Amplatzer occluder. For smaller ducts, we typically use stainless steel coils. Using this strategy, we close all patent arterial ducts, regardless of their size.
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Kogon BE, Forbess JM, Wulkan ML, Kirshbom PM, Kanter KR. Video-assisted Thoracoscopic Surgery: Is It a Superior Technique for the Division of Vascular Rings in Children? CONGENIT HEART DIS 2007; 2:130-3. [DOI: 10.1111/j.1747-0803.2007.00086.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Kypson AP. Recent Trends in Minimally Invasive Cardiac Surgery. Cardiology 2007; 107:147-58. [PMID: 16877865 DOI: 10.1159/000094736] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 04/04/2006] [Indexed: 11/19/2022]
Abstract
Evolving technologies have resulted in an increase in minimally invasive cardiac surgery. Currently, robotic systems allow surgeons to perform a variety of procedures through small incisions. This changing paradigm is reviewed.
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Affiliation(s)
- Alan P Kypson
- Division of Cardiothoracic Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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28
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Abstract
Cardiovascular surgery has traditionally been performed through a median sternotomy, allowing the surgeon generous access to the heart and surrounding great vessels. Recently, less invasive methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart, thus resulting in a paradigm shift in cardiac surgery. Originally, long instruments without pivot points were used, however; with the application of robotic telemanipulation systems that allow for improved dexterity, the surgeon is able to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, this article reviews the recent history and clinical results of robotics in cardiovascular surgery.
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Affiliation(s)
- Alan P Kypson
- Brody School of Medicine, Division of Cardiothoracic and Vascular Surgery, East Carolina University, Life Sciences Building, Room 177, Greenville, NC 27834, USA
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Vanamo K, Berg E, Kokki H, Tikanoja T. Video-assisted thoracoscopic versus open surgery for persistent ductus arteriosus. J Pediatr Surg 2006; 41:1226-9. [PMID: 16818053 DOI: 10.1016/j.jpedsurg.2006.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study is to compare the experience with video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus (PDA) since 1995 with the results of conventional open surgery from the preceding 10 years. METHODS The records of 60 children who underwent standard posterolateral muscle splitting thoracotomy and ligation of PDA in 1986-1995 were reviewed for the study. The data on 50 children who underwent VATS PDA ligation since 1995 were collected prospectively. RESULTS All patients survived. Ductal bleeding requiring sutures with patches occurred once in the open surgery group. Two patients in the VATS group underwent immediate rethoracoscopy and clipping because of residual ductal flow in the postoperative echocardiography. Complications in the VATS group included 6 (12%) recurrent laryngeal nerve injuries (3 transient) and 2 chylothoraces. One patient in each group underwent open reoperation because of residual ductal flow 1 year after the initial operation. The operative time, duration of recovery room/neonatal intensive care unit care, duration of pleural drainage, and length of hospital stay were significantly shorter in the VATS group. CONCLUSIONS VATS PDA ligation gave results equal to traditional open surgery with a shorter operative time, faster recovery, and shorter hospital stay. More complications, especially recurrent laryngeal nerve injuries, occurred in the VATS group.
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Affiliation(s)
- Kari Vanamo
- Department of Pediatric Surgery 2206, Kuopio University Hospital, FIN-70211 Kuopio, Finland.
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30
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Affiliation(s)
- Vladimiro L Vida
- Paediatric Cardiac Surgery Unit, University of Padua Medical School, Italy.
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31
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Villa E, Folliguet T, Magnano D, Vanden Eynden F, Le Bret E, Laborde F. Video-assisted thoracoscopic clipping of patent ductus arteriosus: close to the gold standard and minimally invasive competitor of percutaneous techniques. J Cardiovasc Med (Hagerstown) 2006; 7:210-5. [PMID: 16645388 DOI: 10.2459/01.jcm.0000215275.55144.17] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To review our 12-year experience in video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus. METHODS VATS was performed in 743 patients. Three groups were compared: 24 low-birth-weight infants (LBWIs), 676 children between 2.5-25 kg and 43 boys > 25 kg. A diameter of > 8 mm was the main contraindication. For 85 consecutive patients, hospital stay underwent cost analysis. RESULTS Median age was 1.6 years (range 5 days-33 years) and median weight 9.0 kg (range 1.2-65 kg). Mortality was nil. Median operative time was 20 min and hospital stay 2 days. Residual patency at discharge was 0% in LBWIs, 0.7% in children, and 4.7% in boys (P = NS) and 0, 0.3, and 4.7% at follow-up (P = 0.001). Persistent recurrent laryngeal nerve dysfunction was recorded in 4.2% of LBWIs, 0.3% of children and 0% of boys (P = 0.012). Total mean cost was Euro 5954 +/- 2110. CONCLUSIONS The success rate of VATS clipping compares favorably with the thoracotomic approach but without chest wall trauma and it may have a very favorable cost-effective therapeutic balance compared to transcatheter techniques.
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Affiliation(s)
- Emmanuel Villa
- Cardiac Pathology Department, Institut Mutualiste Montsouris, Paris, France.
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Koontz CS, Bhatia A, Forbess J, Wulkan ML. Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients. Am Surg 2005. [DOI: 10.1177/000313480507100403] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.
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Affiliation(s)
- Curt S. Koontz
- Divisions of Pediatric Surgery, Joseph B Whitehead Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Amina Bhatia
- Divisions of Pediatric Surgery, Joseph B Whitehead Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joe Forbess
- Divisions of Pediatric Cardiothoracic Surgery, Joseph B Whitehead Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Mark L. Wulkan
- Divisions of Pediatric Surgery, Joseph B Whitehead Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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Soukiasian HJ, Fontana GP. Surgeons should provide minimally invasive approaches for the treatment of congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:185-92. [PMID: 15818377 DOI: 10.1053/j.pcsu.2005.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The basis for pursuing techniques for less invasive surgery on children with congenital heart disease is to reduce the known long-term morbidities of thoracotomy and sternotomy. In addition, rapid return to normal activities, reduced length of stay, and better pain control may be achieved. Several congenital lesions have been successfully treated with innovative minimally invasive techniques; however, further technique and technology development is required to accomplish repair of the more complex defects safely and effectively.
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Affiliation(s)
- Harmik J Soukiasian
- Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Abstract
A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for placement of an atrial retractor, as well as needle, tissue, and suture retrieval. With the development of specialized retractors and a delivery/retrieval port, a truly endoscopic approach will be consistently reproducible. New navigation systems and image guided surgery portend an improving future for robotic cardiac surgery. Recently, we have combined robotically guided microwave catheters for ablation of atrial fibrillation with robotic mitral valve repairs (Fig. 8). Thus, we are beginning to achieve the ideal operation, with a native valve repair and a return to normal sinus rhythm. Robotic cardiac surgery is an evolutionary process, and even the greatest skeptics must concede that progress has been made toward endoscopic cardiac valve operations. Surgical scientists must continue to critically evaluate this technology in this new era of cardiac surgery. Despite enthusiasm, caution cannot be overemphasized. Surgeons must be careful because indices of operative safety, speed of recovery, level of discomfort, procedural cost, and long-term operative quality have yet to be defined. Traditional valve operations still enjoy long-term success with ever-decreasing morbidity and mortality, and remain our measure for comparison. Surgeons must remember that we are seeking the most durable operation with the least human trauma and quickest return to normalcy, all done at the lowest cost with the least risks. Although we have moved more asymptotically to these goals, surgeons alone must map the path for the final ascent.
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Affiliation(s)
- Alan P Kypson
- Department of Surgery, The Brody School of Medicine at East Carolina University, Moye Boulevard, Greenville, NC 27858, USA.
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Jacobs JP, Giroud JM, Quintessenza JA, Morell VO, Botero LM, van Gelder HM, Badhwar V, Burke RP. The modern approach to patent ductus arteriosus treatment: complementary roles of video-assisted thoracoscopic surgery and interventional cardiology coil occlusion. Ann Thorac Surg 2003; 76:1421-7; discussion 1427-8. [PMID: 14602261 DOI: 10.1016/s0003-4975(03)01035-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In an effort to analyze our experience and develop treatment guidelines, we reviewed all our patients with patent ductus arteriosus (PDA) treated with video-assisted thoracoscopic surgery (VATS) or interventional cardiology coil occlusion. METHODS One hundred patients underwent 102 cardiac catheterizations. Forty-five children underwent VATS. The entire cohort of patients is 141 because 4 patients underwent both catheterization and VATS. RESULTS Successful PDA coil occlusion occurred in 91 patients (91 of 100; 91%); 8 had unsuccessful attempts at coil occlusion and 1 was referred for surgical ligation after catheterization without any attempt at coil placement. Thirty-nine children had successful VATS PDA closure. Six children required conversion to thoracotomy because of inadequate exposure during VATS. Hospital stay for children more than 45 days of age was as follows: VATS median stay, 1 day, mean, 1.4 days; thoracotomy median stay, 4 days, mean, 4.6 days. One patient treated with PDA coil occlusion developed a recurrent PDA and required reembolization. Three children underwent initial catheterization without successful coil placement with subsequent successful VATS. All VATS patients left the operating theater with echocardiography documenting no residual PDA. Two children who underwent successful VATS with no residual PDA at hospital discharge were found on outpatient follow-up to have developed tiny recurrent PDAs and both were successfully coil occluded; 1 of these 2 children is 1 of the 3 children initially evaluated by catheterization and then referred for VATS. CONCLUSIONS Video-assisted thoracoscopic surgery and coil occlusion represent complementary techniques for PDA treatment. A rationale for selection of the appropriate treatment modality can be based upon the size and age of the patient and the size and morphology of the PDA.
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Affiliation(s)
- Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, All Children's Hospital/University of South Florida College of Medicine, St. Petersburg, Florida 33701, USA.
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Mihaljevic T, Cannon JW, del Nido PJ. Robotically assisted division of a vascular ring in children. J Thorac Cardiovasc Surg 2003; 125:1163-4. [PMID: 12771894 DOI: 10.1067/mtc.2003.52] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomislav Mihaljevic
- Department of Cardiovascular Surgery, Children's Hospital-Boston and Harvard Medical School, Boston, MA 02115, USA
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Chitwood WR, Kypson AP, Nifong LW. Robotic Mitral Valve Surgery: A Technologic and Economic Revolution for Heart Centers. ACTA ACUST UNITED AC 2003; 1:30-9. [PMID: 15785174 DOI: 10.1111/j.1541-9215.2003.02098.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A renaissance in cardiac surgery is occurring. Cardiac operations are being performed through smaller incisions with enhanced technologic assistance. Specifically, minimally invasive mitral valve surgery has become standard for many surgeons. At our institution, we have developed a robotic mitral surgery program with the da Vinci telemanipulation system, which has recently gained Food and Drug Administration approval. This system allows the surgeon to perform complex mitral valve operations through small port sites rather than a traditional median sternotomy. Our techniques and initial results are reported. Despite procedural success, these devices are not inexpensive and hospitals will have to justify their purchase. The implementation of robotic surgery has forced us to compare costs and benefits compared with conventional cardiac surgery. Nevertheless, our desire for improved and less traumatic patient care will drive this new technology, which will serve as a good model for us to study over the next several years.
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Affiliation(s)
- W Randolph Chitwood
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27858, USA.
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Radlinsky MG, Mason DE, Biller DS, Olsen D. Thoracoscopic visualization and ligation of the thoracic duct in dogs. Vet Surg 2002; 31:138-46. [PMID: 11884959 DOI: 10.1053/jvet.2002.31062] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop a technique for thoracoscopic visualization and ligation of the thoracic duct in dogs. STUDY DESIGN In vivo experimental study. ANIMALS Five mature, healthy dogs. METHODS Dogs were normal based on physical examination, negative occult heartworm test, normal complete blood count and biochemical profile, and normal thoracic radiographs. The dogs were anesthetized, and a ventral midline laparotomy was performed for catheterization of a mesenteric lymphatic. Lymphangiography was performed to determine thoracic duct anatomy. Thoracoscopy was performed in the caudal, right hemithorax after single lung intubation or bronchial blockade. At least two 10-mm clips were placed across the thoracic duct in each dog. Lymphangiography was repeated to assess duct ligation. If complete duct occlusion was not achieved, thoracoscopy was repeated for additional clip placement. After surgery the dogs were euthanatized, and necropsies were performed. RESULTS Lymphangiography showed that multiple branches of the thoracic duct were present in every dog; bilateral thoracic duct branches were most common. Thoracoscopic identification and ligation of the thoracic duct was successful in all five dogs. Two dogs required a second thoracoscopic procedure to completely occlude flow of contrast through the thoracic duct. Surgery time for thoracoscopy averaged 59 plus minus 9.6 minutes. Retroperitoneal contrast accumulation after thoracic duct ligation occurred in two dogs. One dog required bilateral pulmonary ventilation. CONCLUSION Thoracoscopy can be used to visualize the thoracic duct for ligation in normal dogs. CLINICAL RELEVANCE Thoracoscopic ligation of the thoracic duct may be a therapeutic option for management of chylothorax in dogs.
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Affiliation(s)
- Maryann G Radlinsky
- Department of Clinical Sciences, Kansas State University, Manhattan, KS 66506-5606, USA
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Felger JE, Nifong LW, Chitwood WR. The evolution of and early experience with robot-assisted mitral valve surgery. Surg Laparosc Endosc Percutan Tech 2002; 12:58-63. [PMID: 12008764 DOI: 10.1097/00129689-200202000-00010] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac surgeons have embraced minimally invasive surgery with warranted enthusiasm. The acceleration of technological advances in optics, instrumentation, and cardiopulmonary bypass has allowed safe, effective, efficient minimally invasive cardiac procedures. In this article we review the evolution of and early experience with robot-assisted mitral valve surgery. Articles by leaders in the field of minimally invasive cardiac surgery, both American and European, are reviewed to describe the development of cardiac robotic surgery. The current state of robotic mitral surgery is described.
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Affiliation(s)
- Jason E Felger
- Center for Robotics and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA
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Felger JE, Nifong LW, Chitwood WR. The evolution and early experience with robot-assisted mitral valve surgery. ACTA ACUST UNITED AC 2001; 58:570-5. [PMID: 16093089 DOI: 10.1016/s0149-7944(01)00557-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiac surgeons, with a warranted enthusiasm, have embraced minimally invasive surgery. The acceleration of technological advances in optics, instrumentation, and cardiopulmonary bypass has allowed safe, effective, and efficient minimally invasive cardiac procedures. In this Technology Focus section, we review the evolution and early experience with robot-assisted mitral valve surgery. The articles of leading minimally invasive cardiac surgeons, both American and European, are reviewed to define the development toward cardiac robotic surgery. The current state of robotic mitral surgery is described.
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Affiliation(s)
- J E Felger
- Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Decampli WM. Video-assisted thoracic surgical procedures in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 1:61-74. [PMID: 11486208 DOI: 10.1016/s1092-9126(98)70012-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The general principles and current applications of pediatric video-assisted cardiothoracic surgery (PVACTS) are reviewed. The purpose of PVACTS is to improve surgical quality and precision in selected operations. In the 1990s PVACTS has expanded to include the management of a variety of pulmonary, mediastinal, and cardiac lesions. Currently, PVACTS is carried out using a video camera connected to a low-profile scope and a specialized set of surgical instruments. PVACTS is an accepted modality for the diagnosis (by biopsy) of pleuropulmonary and mediastinal disease, and the treatment of pediatric empyema, spontaneous pneumothorax, and mediastinal cysts. Diaphragmatic plication, repair of chylous leak, and ligation of collateral vessels have all been done using PVACTS. PVACTS patent ductus arteriosus (PDA) ligation and vascular ring repair are being successfully carried out in several institutions. The technique at The Children's Hospital of Philadelphia is described. Indications and techniques for PVACTS lobectomy and pneumonectomy are less well established. Suggested anecdotal methods are described. Cardioscopy carries the hope of improving intracardiac repair, and has been applied to several lesions. The future of PVACTS depends on the surgeon's willingness to master it, industry's willingness to customize instruments for pediatric use, and developments in the fields of virtual imaging and augmented reality. Copyright 1998 by W.B. Saunders Company
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Affiliation(s)
- William M. Decampli
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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Muralidhar K, Shetty DP. Ventilation strategy for video-assisted thoracoscopic clipping of patent ductus arteriosus in children. Paediatr Anaesth 2001; 11:45-8. [PMID: 11123730 DOI: 10.1046/j.1460-9592.2001.00614.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Video-assisted endoscopic techniques have reduced operative trauma in adult thoracic and general surgery but its application in children with congenital heart disease has been limited. We report the use of video-assisted thoracoscopic (VAT) technique of clipping patent ductus arteriosus (PDA) in children. Forty patients with PDA were divided into two groups: during VAT surgery patients in group A [mean age=3.6 +/- 2.4 (SD) years] were managed with right main stem bronchial intubation and those in the group B [mean age=3.7 +/- 2.7 (SD) years] received low tidal volume-high frequency ventilation using a Siemens 900C ventilator. The mean oxygen saturation (SpO2) observed during the surgical intervention was significantly lower in group A (90%) compared to group B (96.8%) while the surgical convenience was not different. We conclude that a low tidal volume-high frequency ventilation is acceptable and safe in patients with PDA undergoing VATS.
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Giamberti A, Mazzera E, Di Chiara L, Ferretti E, Pasquini L, Di Donato RM. Right submammary minithoracotomy for repair of congenital heart defects. Eur J Cardiothorac Surg 2000; 18:678-82. [PMID: 11113675 DOI: 10.1016/s1010-7940(00)00589-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The initial experience with the right submammary minithoracotomy incision for correction of intracardiac congenital defects is reported. METHODS Between March 1997 and March 1999, 100 children underwent repair of congenital heart disease through this approach. Their mean age and weight were 4.6 years and 20 kg, respectively. Diagnosis included: atrial septal defect (78), ventricular septal defect (7), tetralogy of Fallot (6), partial atrioventricular canal (5), double-chambered right ventricle (3) and single ventricle with dextrocardia (1). The standard technique entailed a 5 to 6 cm right submammary incision, entering the chest through the third or fourth intercostal space (depending on the body weight), direct aortic and bicaval cannulation and aortic cross-clamping with cardioplegic protection. RESULTS There were no hospital deaths. Postoperative morbidity included bleeding in two cases, recurrent atrial septal defect in one, spleen injury in one. The average hospital stay was 3.5 days. All patient are currently free of symptoms and medications. CONCLUSIONS (1) This approach for repair of selected congenital cardiac malformations is technically feasible, safe and effective; (2) younger age is a facilitating factor; (3) hospital stays are effectively reduced.
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Affiliation(s)
- A Giamberti
- Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, P.zza S. Onofrio, 400165, Rome, Italy
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Abstract
While describing the circulatory system in De Moto Cordis, in 1628, William Harvey developed precepts for investigation, which could be modified slightly to guide the adoption of new technology and technique in the twenty-first century. Harvey might suggest (1) careful and accurate observation and description of a new technique, (2) a tentative explanation of how the technique improves on existing techniques, (3) a controlled testing of the hypothesis, and (4) conclusions based on the results of the experiments. Also, he might admonish surgery today, with its massively enhanced capabilities for information management, to rigorously test the validity of these conclusions with quantitative reasoning. In the future, precise measurement of the "trauma" of surgery, or even an individual surgeon, may be possible, and the long-term impact of a chest wall incision on a patient's self-esteem may be predictable. Absent such objective measures, justifications for "minimally invasive" deviations from conventional technique in surgery for CHD lack substance. Morbidity, mortality, and physiological endpoints will continue to form the foundation for therapeutic plans; however, the potential for emerging technology to reduce the trauma of these plans remains tantalizing.
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Affiliation(s)
- R P Burke
- Division of Cardiovascular Surgery, Miami Children's Hospital, FL 33155-4069, USA.
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Odegard KC, Kirse DJ, del Nido PJ, Laussen PC, Casta A, Booke J, Kenna MA, McGowan FX. Intraoperative recurrent laryngeal nerve monitoring during video-assisted throracoscopic surgery for patent ductus arteriosus. J Cardiothorac Vasc Anesth 2000; 14:562-4. [PMID: 11052439 DOI: 10.1053/jcan.2000.9447] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop a technique to identify and localize the recurrent laryngeal nerve (RLN) during video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus. DESIGN Prospective clinical study. SETTING Children's hospital. PARTICIPANTS Sixty infants and children scheduled for elective closure of patent ductus arteriosus. INTERVENTIONS With parental informed consent, 60 infants and children undergoing elective VATS for patent ductus arteriosus were studied. A thin, pencil-point, Teflon-coated, stimulating probe allowed direct stimulation (<2 mA, 100-msec pulse width) of the left RLN inside the thorax. A commercially available 4-channel neurologic monitor recorded compound evoked electromyograms (EMGs) from the left RLN and right RLN (as control) by needle electrodes placed percutaneously in the neck. Hoarseness, stridor, feeding difficulties, and voice changes were assessed postoperatively. MEASUREMENTS AND MAIN RESULTS Left RLN EMGs were easily obtained in 59 of the 60 patients. The surgeon correctly identified the RLN visually once in the first 7 patients; this ability subsequently improved. EMG localization of the location or course of the RLN altered dissection, clip size, or clip position in 37 of 59 patients. CONCLUSION Intraoperative EMG to identify location and route of the RLN was easy to perform, was effective in identifying RLN position, and appeared to facilitate dissection and clipping of the ductus.
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Affiliation(s)
- K C Odegard
- Department of Anesthesiology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Miyaji K, Hannan RL, Ojito J, Dygert JM, White JA, Burke RP. Video-assisted cardioscopy for intraventricular repair in congenital heart disease. Ann Thorac Surg 2000; 70:730-7. [PMID: 11016302 DOI: 10.1016/s0003-4975(00)01497-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgical techniques have been widely adopted as a means to reduce surgical trauma. By adapting pediatric thoracoscopic instrumentation, we have developed a technique for video-assisted cardioscopy (VAC). We report our experience and describe the technical feasibility of VAC. METHODS Since June 1995, 409 consecutive patients underwent 431 intracardiac procedures (ventricular septal defect, 150; tetralogy of Fallot or double outlet right ventricle, 101; atrioventricular canal, 52; subaortic stenosis, 43; valve repair, 50; Rastelli procedure, 12; Konno or Ross Konno operation, 11; and miscellaneous, 12) using VAC at Miami Children's Hospital. Using a prospective database, we tracked outcomes and operative events to delineate the usefulness and efficacy of this technique. RESULTS VAC provided clear and precise imaging of small or remote intracardiac structures during repair of congenital heart defects without technical complications. Procedure times and aortic cross-clamp times using VAC were not prolonged. Intraoperative images were collected for every operation, documenting each patient's cardiac anatomy before and after repair. Surgery through small incisions was facilitated. Operative mortality was 1.2% (5 of 409), and no patient required reoperation before discharge. At a mean follow-up interval of 22 months, the incidence of reoperation for residual or recurrent lesions was 1.2% (5 of 404). CONCLUSIONS Our experience demonstrates the technical feasibility and clinical utility of routine endoscopic imaging during open heart surgery for congenital heart repair.
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Affiliation(s)
- K Miyaji
- Department of Cardiovascular Surgery, Miami Children's Hospital, Florida 33155-4069, USA
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Abstract
An infant with cyanotic heart disease that was palliated with a bidirectional cavopulmonary shunt developed progressive cyanosis 3 months after the surgical procedure. A large hemizygous vein was found to be decompressing the bidirectional Glenn shunt from the left innominate vein and was ligated using video-assisted thoracoscopic surgery. The unusually rapid appearance of the shunt, and the excellent outcome associated with the video-assisted thoracoscopic surgery procedure are discussed.
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Affiliation(s)
- R M Payne
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1081, USA.
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