J Thorac Cardiovasc Surg 2005;129:1462
© 2005 The American Association for Thoracic Surgery
Effect of right anterolateral thoracotomy on breast development and scoliosis
John S. Murala, MCh,
Ravi Agarwal, MCh,
Kotturathu Mammen Cherian, MS, DSc(Hons), FRACS
International Centre for Cardiothoracic and Vascular Diseases, Chennai, India
To the Editor:
We read with great interest the article "The Influence of Right Anterolateral Thoracotomy in Prepubescent Female Patients on Late Breast Development and on the Incidence of Scoliosis" by Bleiziffer and associates.1 We agree with the authors that the right anterolateral thoracotomy should be abandoned in prepubescent female patients. In fact, we have been using a limited posterior thoracotomy incision for correction of simple congenital heart defects since 1998, and we have also published our data previously.2 Earlier studies in young women have also shown that classic anterior and anterolateral thoracotomy incisions lead to unequal breast development.3
Just to update our recent data, we analyzed 35 patients who underwent right posterior thoracotomy from February to October 2004 at our institution. Thirty-one underwent operation for secundum atrial septal defect, 2 for ventricular septal defect closure, and 1 each for repair of tetralogy of Fallot (not requiring transannular patch) and partial atrioventricular canal defect. Ages ranged from 3 to 28 years (mean, 13 ± 4 years). A standard right posterior thoracotomy incision was made with the anterior limit up to the posterior axillary line. Cardiopulmonary bypass was instituted by using aortic and bicaval cannulation, and intracardiac repair was performed under fibrillatory or cardioplegic arrest per the surgeons’ choice. All patients survived the operation and were extubated within 12 hours after surgery. The mean stay in the intensive care unit was 24 ± 6 hours. None had phrenic nerve palsy or excessive blood loss. In the postoperative period, there was no short-term limitation of movement of the upper limb. All patients except 2 were discharged on the eighth postoperative day. One had significant residual shunt and had to undergo reoperation through a median sternotomy, and another had a persistent air leak that stopped after 5 days. There was no wound infection.
We believe that right posterior thoracotomy is safe and reproducible and does not require sophisticated equipment. It gives a good scar, which is invisible from the front and is masked by typically worn apparel. It does not interfere with future development and modeling of the breast.
 |
References
|
|---|
- Bleiziffer S, Schreiber C, Burgkart R, Regenfelder F, Kostolny M, Libera P, et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J 2004;127:1474-1480.
- Shivaprakasha K, Murthy KS, Coelho R, Agarwal R, Rao SG, Planche C, et al. Role of limited posterior thoracotomy for open heart surgery in the current era. Ann Thorac Surg 1999;68:2310-2313.[Abstract/Free Full Text]
- Cherup LL, Siewers RD, Futrell JW. Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children. Ann Thorac Surg 1986;41:492-497.[Abstract]
Related Article
-
Reply to the Editor
- Sabine Bleiziffer, Christian Schreiber, and Ruediger Lange
J. Thorac. Cardiovasc. Surg. 2005 129: 1462.
[Extract]
[Full Text]
[PDF]
Top
References