The patient was a 6-year-old boy with no symptoms and a finding of a systolic heart murmur on the left sternal border on a routine examination. Echocardiogram showed left ventricular outflow tract obstruction by subaortic fibrous membrane with a peak gradient of 76 mm Hg and mild aortic valve regurgitation with preserved left ventricular function.
The authors’ operation plan consisted of right axillary minithoracotomy with central cannulation for CPB, institution of cold blood cardioplegia in the aortic root, and subaortic membrane resection through the aortotomy. The operation was performed through the right axillary minithoracotomy in the 4th intercostal space between anterior and posterior axillary lines.
After transverse aortotomy, the aortic valve leaflets were retracted exposing the subvalvular obstruction. A combination of sharp and blunt dissection was used to enucleate the circumferential shelf off the ventricular septum and the anterior leaflet of the mitral valve. The hypertrophied portion of the interventricular septum was resected together with fibrotic tissue. Inspection of the aortic valve confirmed normal coaptation.
The patient’s postoperative course was unremarkable and he was discharged home on postoperative day four. The patient is currently doing well as an outpatient.
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Excellent video. Glad to see that cardiopathies other than ASD & VSD are approached through minimally invasive incisions. Axillary approach (4th, maybe 3rd intercostal space) looks appropriate to reach the aortic root. Thanks for sharing.
What is the youngest age at which this approach can be used?
And is there a minimum weight for using this approach?
The youngest patient that we used axillary approach had TOF and was 2 months old and 6-7kg
Very nice video. What did you use for video camera? Thanks