CLOSING CONGENITAL HEART HOLE WITH SMALL INCISION (CLOSED METHOD)

The treatment of Atrial Septal Defect or Ventricular Septal Defect by “Closed method” in other words, the small incision has started being used routinely. It has its own advantages cosmetically and it also provides huge comfort during the post operative period for the patient. These patients are protected from osteotomy, in this way the risk of infection and bleeding are reduced.

Atrial septal defect (ASD) is a congenital hole in the wall between the chambers of the heart called atrium. It is usually detected by chance during routine check-ups. Since this situation is a surprise for the patient, how to close this hole is also an important issue. The decision on how to close the hole is made according to its size and location. These intracardiac holes can be closed in some patients with interventional methods. However, in this case, the hole should not be large, should not be close to the aorta, and the patient should not have a nickel allergy. In other words, not every hole can be closed by entering from the groin and using angiography. Therefore, a surgical method is needed. In surgical methods, minimally invasive treatment has now begun to take hold. In other words, this surgery, which is performed with 3-4 cm incisions under the right breast (in the armpit as patients call it), leaves no scars, especially in women.

Minimally invasive heart surgery, which is performed with a small incision or the Underarm Heart Surgery method, has become widespread after 1995. Compared to traditional heart surgeries performed by opening the chest, there is less bleeding, less need for blood transfusion, less infection, less pain, less use of painkillers, less hospitalization, and better cosmetic appearance (1). However, vascular complications such as arterial rupture and venous clotting have also been reported due to the procedure performed in the groin to connect the patient to the heart-lung machine (2).

ASD closure with a minimally invasive method can be done with a mini-thoracotomy (i.e. under the armpit), an incision under the right breast, or with a robot. In both methods, the inguinal artery and vein are entered through an approximately 2 cm incision, connected to the heart-lung machine, and the heart is stopped. In mini-thoracotomy, an approximately 4-5 cm incision is made under the right breast (under the armpit), the bone is not cut, only the ribs are separated, and the right atrium of the heart is reached. Depending on the size of the hole, the ASD is either closed with direct sutures or with a patch prepared from the pericardium. The duration of the surgery is quite short. Patients recover in a short time and are discharged.

This type of “closed method” or “underarm” minimally invasive, that is, “small incision” heart surgery gives patients an incredible positive energy, and this positive energy positively affects the course of the surgery. Since it is a protective treatment (there is less infection, bone displacement, bleeding, etc.), the feedback from patients is quite positive (1).

resources

1- Uymaz B, Sezer G, Köksal Coşkun P, Tarcan O, Ozleme S, Aybek T. Clinical outcome, pain perception and activities of daily life afer minimally invasive coronary artery bypass grafting. Anaolu Kardiyol Derg. 2014 Mar; 14(2): 172-7

2- Jeanmart H, Casselman FP, De Grieck Y, Bakir I, Coddens J, Foubert L, Van Vaerenbergh G, Vermeulen Y, Vanermen H. Avoiding vascular complications during minimally invasive, totally endoscopic intracardiac surgery. J Thorac Cardiovasc surg. 2007 Apr; 133(4): 1066-70