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Strategy for ventricular septal defect closure after prior gastric pull-through

Sivalingam S, Krishnasamy S, Yakub MA

Asian Cardiovasc Thorac Ann, 2015 Jun;23(5):612-4.
PMID: 24962807 DOI: 10.1177/0218492314540667

A 9-year-old boy was referred with a perimembranous ventricular septal defect. At birth, he had undergone a right thoracotomy with ligation of a tracheoesophageal fistula, cervical esophagostomy, and feeding gastrostomy. At 2 years of age, he had gastric tube reconstruction with a pull-through retrosternally, anterior to the heart, and an end-to-end esophagogastric anastomosis. Via a right anterolateral thoracotomy through the previous scar, the entire gastric tube was mobilized away from the sternum to facilitate a median sternotomy. With the patient supine, a median sternotomy was performed without difficulty, and the ventricular septal defect was closed under cardiopulmonary bypass.

Matched MeSH terms: Thoracotomy/methods*
Simultaneous bypass grafting of the superior vena cava and intrathoracic biopsy in fulminant superior vena caval syndrome

Majid AA

J R Coll Surg Edinb, 1991 Dec;36(6):406-8.
PMID: 1774712
Matched MeSH terms: Thoracotomy/methods
Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

Tan JH, Ng ZQ, Tan HCL, Vendargon S

BMJ Case Rep, 2018 Jun 27;2018.
PMID: 29950501 DOI: 10.1136/bcr-2018-224741

A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm3 of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.

Matched MeSH terms: Thoracotomy/methods
Closure of the patent ductus arteriosus with a Ligaclip through a minithoracotomy

Majid AA

Chest, 1993 May;103(5):1512-4.
PMID: 8486035 DOI: 10.1378/chest.103.5.1512

This article describes a technique which allows the patent ductus arteriosus (PDA) to be closed through a minithoracotomy. It combines a simple method of inducing atelectasis with Ligaclip closure of the PDA through a subaxillary incision. It was used successfully in 11 children and adolescents.

Matched MeSH terms: Thoracotomy/methods*
Anesthetic management of thoracoscopic resection of lung lesions in small children

Mohtar S, Hui TWC, Irwin MG

Paediatr Anaesth, 2018 11;28(11):1035-1042.
PMID: 30281181 DOI: 10.1111/pan.13502

BACKGROUND: Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described.
AIMS: This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery.
METHODS: We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed.
RESULTS: Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point.
CONCLUSION: One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.

Matched MeSH terms: Thoracotomy/methods