Thoracotomie postero-laterale droite pour la chirurgie a coeur ouvert chez l'enfant. Indications et resultats

In order to avoid the aesthetic prejudice of median sternotomy in young children undergoing open heart surgery for isolated congenital heart disease, a right posterolateral thoracotomy was performed in 146 children aged 5 months to 14 years. The large majority (140/146, 96%) were atrial septal defects: 130 ostium secundum, 5 sinus venosus, 1 low septal defect and 4 ostium primum (partial endocardial cushion defect). Six children had isolated perimembranous ventricular septal defects. One patient died of a probable lesional pulmonary oedema. Minor complications were observed in 15 cases and one had to be reoperated for a residual shunt. With an average follow-up of 2.6 years, all survivors are asymptomatic. The scar is normal, without cheloid or thoracic deformation, invisible to the patient when he looks in a mirror. The use of this approach requires a very accurate anatomical diagnosis, especially with regards to systemic and pulmonary drainage. The presence of a left superior vena cava draining into the coronary sinus is a contra-indication. The right posterolateral thoracotomy is now the approach of choice in its standard indication, the repair of ostium secundum atrial septal defects with large shunts, in young girls under 10 years of age.