右腋下微创小切口经左心房入路行成人复杂房间隔缺损修补术的临床应用

Clinical experience of adult complex atrial septal defect repair through left atrial approach through minimally invasive incision in right axilla

目的 探讨右腋下微创小切口经左心房入路行成人复杂房间隔缺损修补术的临床应用。方法选取2019年12月至2021年10月浙江省人民医院心脏大血管外科收治的33例房间隔缺损患者的临床资料,年龄40~60岁。患者均接受胸腔镜辅助下无可见瘢痕右腋下微创手术,股动静脉插管建立体外循环,经左心房路径行房间隔缺损修补。结果 全组患者均顺利完成手术,无术后低心排综合征、术后心力衰竭、恶性心律失常等严重并发症发生。术后经胸超声心动图监测结果提示,未见明显穿隔血流,修补满意。结论无可见瘢痕右腋下微创小切口经左心房入路行复杂房间隔缺损修补术安全有效,可以提供较好的美容效果及良好的手术疗效。

Objective To investigate the clinical application of the right subaxillary minimally invasive incision through the left atrium approach to repair complex atrial septal defect without visible scar.Methods The data of 33 patients with atrial septal defect admitted to the Department of Cardiology and Macrovascular Surgery of Zhejiang Provincial People’s Hospital from December 2019 to October 2021 were selected.All the patients received minimally invasive surgery though the right subaxilla with no visible scar assisted by thoracoscopy;extracorporeal circulation was established through femoral arteriovenous intubation,and the atrial septal defect repair was performed through the left atrial path.Results All the patients were successfully operated without postoperative low cardiac output,postoperative heart failure,malignant arrhythmia and other serious complications.Postoperative transthoracic echocardiography showed no obvious transseptal blood flow and the repair was satisfactory.Conclusion It is safe and effective to repair complex atrial septal defect through the left atrial approach via the minimally invasive incision under the right axilla without visible scar,which can provide good cosmetic effect and surgical efficacy.