1. Are there really so many disadvantages of median incision?
For a median thoracic incision longitudinally splitting the sternum. Several disadvantages are commonly stated.
(1) “Big trauma”, not so terrible.
(2) “Prone to incision and sternal infection”, the incidence is not.
(3) “Permanent legacy of wires”, many children can use sternal sutures without wires.
(4) “destruction of the bony scaffold of the thorax, high incidence of postoperative chicken chest”, in the past all were median open chest, most did not have chicken chest.
The main problem, in my opinion, is the location in the anterior chest. Regardless of the length, size and obviousness of the scar, it must affect the aesthetics and must have a psychological impact on the child.
2.Why choose the right side incision?
At present, the safety of surgery for simple precordial disease is no longer a problem in larger heart centers, and the mortality rate is almost zero. The quality of life after surgery becomes an issue second only to the surgical effect.
3.What are the advantages of right-sided open heart?
It is located in the anterior axillary line and posterior axillary line, i.e. “under the axilla”.
(1) It is far away from the breast and anterior chest muscle tissue, so that its development is not affected.
(2) The location is hidden, located in the right armpit, hanging down the arm, can not see anything, cosmetic effect is good.
(3) Keeping the continuity of the thorax, avoiding the chicken chest caused by longitudinal splitting of the sternum.
(4) Small trauma, less bleeding, quick recovery, and low incidence of surgical incision infection.
While the intracardiac deformity is corrected, the trauma is reduced, especially for the child’s future psychological impact is small, and for girls, it is more significant. It improves the quality of life of the child in the future.
4.What are the disadvantages of right-sided open heart?
(1) The diagnostic level is not high, and the chance of intraoperative emergencies will be correspondingly higher, so right-sided open chest is not recommended. On the other hand, Director Liu Yinglong is comfortable with many small cardiac center surgeries and encounters very specific diagnostic errors.
(2) A certain amount of formal training is required, which should be based at least on proficiency in median open-heart surgery and a certain amount of special problem management skills.
(3) In some cardiac centers, accidents occurred in the early stage of right-sided open-heart surgery, which led to “ten years of fear of the well”, and until now, right-sided open-heart surgery is still considered “unsafe”.
5.Is it safe?
The primary requirement for surgery is safety, but safety can be aesthetically pleasing at the same time. Why not. Our center, of course, will not sacrifice safety for aesthetics. However, any requirement for “100%” is not “guaranteed”, nor is it possible for any doctor to “guarantee” open heart surgery.
6.How long is the incision?
The length of the incision is related to many factors such as age and weight. Generally, 5-10cm. The location is hidden and the length is secondary.
7.Does it affect the outcome of the surgery?
For simple precordial disease, there is no difference with the result of median open heart. For complex precordial disease, some mild cases are also selected and the right side open chest is chosen.
8.Does it require broken ribs?
We never operate that way. Even for a 90 kg adult with right-sided open chest, there is no need to cut off the ribs.
9.Which precordial diseases are suitable?
Atrial septal defect, ventricular septal defect, pulmonary stenosis, triple atrial heart, right ventricular double chamber heart, partial type of pulmonary vein ectopic drainage, partial type of endocardial cushion defect, tetralogy of Fallot, mitral valvuloplasty, tricuspid valvuloplasty, etc.
10.In those cases, the surgery is difficult?
We believe that the technique is technically demanding in cases with combined patent ductus arteriosus, permanent left superior vena cava, right ventricular outflow tract stenosis, and sub-stem ventricular septal defect. Many centers are unable to perform this technique for this reason.
11.Which precordial diseases are relatively contraindicated?
Caution should be exercised in the use of this surgical pathway in children with bi-directional Greene surgery, combined left-sided pulmonary dysplasia, severe pulmonary hypertension, recent co-infection, and children younger than 3 months of age.
12.What are the absolute contraindications for precordial disease?
Preoperative diagnosis is unclear, X-ray suggests the presence of severe adhesions in the right pleura, combined with very poor pulmonary vascular development or significant stenosis at the beginning of the left pulmonary artery TOF and more complex congenital heart malformation correction are absolute contraindications to surgery.
13.Do I need a special signature to indicate the location of the surgical incision before surgery?
In our center, simple congenital heart disease, age and weight appropriate, routine right-sided open heart, no special instructions are needed. For those with special problems, we need to decide the surgical incision after communicating with parents.
14.The suitable age?
I think, half to 5 years old.
15.Appropriate weight?
I think, 6 to 20 kg.
16.Will it affect breast development?
No. There are foreign studies long ago, and the conclusion is that the right anterior side opening will affect the breast development, and the right lateral incision should be made.
17.Will it cause scoliosis?
No, the same literature, concluded that there is no spinal effect. In fact, the surgery in general thoracic surgery in any children’s hospital has been a lateral open chest for decades and has not changed. The doctor who made this? The physician who made this hearsay point is also doing right-sided open-chest surgery at the center under his jurisdiction, and it intensified shortly after this point was made.
18. Is it better than medical intervention?
Internal interventions have their indications. The ones that are suitable and successful are, of course, the best, non-invasive.