Right thoracotomy approach for open heart surgery.

Background: Median sternotomy approach provides excellent exposure of all the chambers of heart for performing open heart surgery, but this approach is the most invasive used for any surgical procedure. Besides an ugly scar, median sternotomy not only increases the morbidity but at times mortality also. To have an acceptable postoperative scar and to avoid the morbidity and mortality associated with median sternotomy, the present study was conducted to find an alternative to median sternotomy in patients with atrial septal defect, mitral and tricuspid valve disease. Methods: Patients were positioned with right side elevated 30-45 degree, and heart was approached by right anterior thoracotomy, through 4th intercostals space. Pericardium was opened anterior to phrenic nerve, and upper end pericardial stay sutures given to get aorta more anterior. Aortic and bicaval cannulation was done and intracardiac procedures were performed as are done after standard median sternotomy. Results: Difficult aortic cannulation and fracture to costochondral junction was the problem observed in some patients. Repair of atrial septal defect was the most common operation performed. Sternotomy, rib resection and peripheral cannulation was not needed in any of these patients. Post-operative period was uneventful in majority. Conclusions: In all patients above 4 years of age, with normal aortic valve, without active lung disease / previous right thoracotomy, having isolated atrial septal defects, mitral and tricuspid valve disease the heart should be approached through right anterior thoracotomy.

Role of Routine Chest Roentgenography in Patients with Open Heart Operation

Three hundred and seventy four random patients admitted to the postoperative intensive care unit (lCU) underwent postoperative clinical positioning of endotracheal tube(ET), nasogastric tube, central venous catheter and laboratory arterial blood gas (ABG) assessment. Chest roentgenography was done for all the admitted patients and the findings reviewed. Thirteen (3.47%) patients required intervention because of abnormalities detected on chest roentgenography. None of the pathologic conditions detected was life threatening. Chest roentgenography on admission to the cardiovascular ICU should be done only if the surgery has been performed for cardiac trauma, re-exploration, and also if clinical and laboratory assessment indicate the possibility of underlying pathologic conditions that can only be confirmed by chest roentgenography.

Selective Use of Chest Tubes in Congential Extracardiac Surgeries

Eight two patients operated for congenital cardio vascular disease are presented. All were selected to be managed without chest tube drainage after thoracotomy. However. in 1.4( 17.07%) patients chest tube drainage was necessitated at operation and of the 68(82.93%) patients. 4(5.88%) underwent an uneventful post operative chest tube insertion. Except on two occasions all the patients had uneventful post operative period. To reduce complications post operative hospital stay and unnecessary forgin body in chest we have employed a seleclive use of chest lubes for some common congenital cardiovascular disorders.