Totally endoscopic atrial septal defect repair using transthoracic aortic cannulation in a 10.5-kg-boy
Journal – International journal of surgery case reports
Publication date – Oct – 2018
Authors – Dang, HQ; Le, HT; Ngo, LTH
Keywords – Atrial septal defect; CO(2) insufflation; Direct aortic cannulation; Minimally invasive cardiac surgery; Totally endoscopic surgery
Open access – Yes
Speciality – Paediatric surgery
World region South-eastern Asia
Language – English
Submitted to the One Surgery Index on October 30, 2018 at 8:21 pm
Although totally endoscopic surgery (TES) has been widely applied for the treatment of atrial septal defect (ASD), small children receive few benefits from this technique due to risks of the femoral cannulation.
A 23-month-old boy, weighing 10.5 kg, with the diagnosis of sinus venosus ASD underwent successful repair by TES. We performed this surgery through 4 small trocars (one 12 mm trocar and three 5 mm trocars), without robotic assistance. In this case, we inserted the arterial cannula directly into the ascending aorta instead of the femoral artery (FA). The defects were repaired on the beating heart with CO2 insufflation.
Femoral cannulation in small children pose some risks, such as increased arterial line pressure, critical lower limb ischaemia, and post-operative iliac or femoral arterial stenosis. Putting the arterial cannula directly into the ascending aorta is a good solution but is difficult to be performed through TES, especially in small children. The major concern of operating on the beating heart is the air embolism, which requires special preventative methods.
Transthoracic aortic cannulation may facilitate TES in small children. However, the safety and efficacy of this approach needs to be validated by larger studies preferably randomised controlled trials.
OSI Number – 20263
PMID – 30336384