Right Axillary Thoracotomy for Transatrial Repair of Congenital Heart Defects: VSD, Partial AV Canal With Mitral Cleft, PAPVR or Warden, Cor Triatriatum, and ASD

Abstract

For transatrial repair of congenital heart defects and wanting to avoid a sternotomy, the muscle-sparing right axillary thoracotomy has the advantage over other thoracic incisions to be far from breast tissue, allowing faster functional recovery, and being more cosmetic. Initially limited to closure of an atrial septal defect, extended application using either induced ventricular fibrillation or aortic cross-clamping with cardioplegic arrest expanded the approach to repair of ventricular septal defects (with or without a subaortic membrane), partial atrioventricular canal with a mitral valve cleft, partial anomalous pulmonary venous return (including the Warden procedure), and more recently cor triatriatum through left and right atrial incisions. The technique is repro.ducible and safe, the quality of repair uncompromised (no residual defects or complications), and the morbidity reduced with shorter hospital stays and faster return to functional capacity, not to mention superior cosmetic results with a vertical scar hidden underneath a resting arm.