HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bleiziffer, S. Articles by Lange, R. Search for Related Content PubMed Articles by Bleiziffer, S. Articles by Lange, R. Related Collections Related Article

J Thorac Cardiovasc Surg 2005;129:1462
© 2005 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

German Heart Center, Munich, Germany

We appreciate the comments of Murala and colleagues on our study "The Influence of Right Anterolateral Thoracotomy in Prepubescent Female Patients on Late Breast Development and on the Incidence of Scoliosis."¹ The correspondents describe a right posterolateral thoracotomy for the repair of atrial septal defect, ventricular septal defect, and tetralogy of Fallot to avoid impaired breast development after an anterior incision.

However, the division or incision of the latissimus dorsi and serratus anterior muscle produces significant trauma to the chest and may cause substantial perioperative morbidity and long-term disability.^2,3 With this in mind, we developed our own modification of a limited midaxillary thoracotomy,⁴ avoiding both damage of future breast tissue and dissection of large muscle groups. Beginning at the height of the mammary areola in the midaxillary line, a 4.5- to 6.0-cm skin incision passes posteriorly toward the tip of the scapula. The entire anterior border of the latissimus dorsi muscle is freed. The muscle can then be retracted posteriorly, exposing the serratus anterior muscle. This muscle is split in a longitudinal manner, and the thorax is opened in the bed of the fourth rib. Cardiopulmonary bypass is instituted by direct bicaval and aortic cannulation. Femoral or iliac cannulation is not used in any patient. Our described surgical approach in 40 consecutive prepubescent patients so far, with a minimum weight of 15 kg, represents a favorable surgical alternative.

	References

Top References

 

1. Bleiziffer S, Schreiber C, Burgkart R, 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.
   
2. Landreneau RJ, Pigula F, Luketich JD, et al. Acute and chronic morbidity differences between muscle-sparing and standard lateral thoracotomies. J 1996;112:1346-1350discussion 1350-1.
   
3. Benedetti F, Vighetti S, Ricco C, et al. Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. J 1998;115:841-847.
   
4. Schreiber C, Bleiziffer S, Lange R. Midaxillary lateral thoracotomy for closure of atrial septal defects in pre-pubescent female children. reappraisal of an "old technique.". Cardiol Young 2003;13:567.
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bleiziffer, S. Articles by Lange, R. Search for Related Content PubMed Articles by Bleiziffer, S. Articles by Lange, R. Related Collections Related Article