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Times Of India
06 Oct 2012
Pune, India.
Doctors Adopt New Approach To Perform Surgery Through 6–CM Incision In The Chest

Postponing his marriage was the last thing on his mind when a 27–year–old man was asked to undergo an urgent heart surgery. He was diagnosed with a hole in the heart, medically known as ‘ventricular septal defect’ The revelation came as shock as his marriage was scheduled to take place in two months’ time.

The conventional surgery involves cutting the breast bone (sternum) to fix the hole, leading to long hospital stay and recovery time. However, the doctors at Jehangir hospital adopted a minimally invasive approach and performed the surgery through a 6–cm incision in the right chest without cutting the sternum. The patient was discharged on the third day after surgery. He returned to normal activities within a week and is now busy in his marriage related arrangements.

"The approach is called ‘lateral thoracotomy’, wherein a small incision was made on the right chest of the patient to fix the hole in the heart. In conventional surgery, this requires a bigger incision in the front of the chest and cutting of the breast bone, which usually takes three months to heal. In this old procedure, the patient’s movements are restricted for at least three to six months. However, in minimally invasive approach, the patient can be back to work in 15 days," said cardiac surgeon Chandrashekhar Kulkarni, who conducted the surgery.

In the present case, the ventricular septal defect (VSD), measuring approximately 10 mm in diameter, was causing overload on the right half of the patient’s chest. The surgery was done on September 21 and the patient was discharged on September 24.

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In a conventional approach, bone healing takes two to three months and, hence, the chances of catching infection in the bone are higher, Kulkarni said.

"This new approach to repair the VSD through the chest eliminates the risk without compromising on the safety and efficacy of the procedure. This also has the potential to speed up the recovery process due to less injury and also does not hamper the activities of the patient," said Kulkarni who has performed nearly 90 heart surgeries through this approach in the past two years.

"Among women who are in an advanced age and who have osteoporosis, the inherent strength of the breast bone is less. So, women patients stand to benefit more from this approach," Kulkarni said.

Cutting breast bone is a conventional approach for correction of cardiac defects. But a midline scar may be unsightly and can provoke displeasure and psychological distress, especially in young patients.

In the minimally invasive approach, the final scar is about 6–cm long on the right side of the chest and, hence, it is also cosmetically superior, especially in women, Kulkarni said.

"As the safety of cardiac operations has increased, more emphasis has been put on cosmetic results after operation. Therefore, lateral thoracotomy can be used in many cases," Kulkarni said.

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"It is for the first time that this procedure was attempted in Pune city," said George Eapen, CEO of the hospital. "Apart from not cutting any bone, the pain and post–operation complications like infection are minimised. This is true for all types of cardiac surgeries like bypass, valve replacements and other congenital heart surgeries. It requires special skill, instruments and access ports to do this procedure."

Ventricular septal defect

A ventricular septal defect (VSD), also called a hole in the heart, is a common defect that is present at birth (congenital). It involves an opening (hole) between the heart's lower chambers, allowing oxygen–rich and oxygen–poor blood to mix.

Ababy with a small ventricular septal defect may have no problems. Ababy with a larger VSD or associated heart defects may have a telltale bluish tint to the skin (cyanosis) due to oxygen–poor blood —often most visible in the lips and fingernails. VSDs are sometimes not diagnosed until adulthood.

Fortunately, VSD is treatable. Many small VSDs often close on their own or do not cause problems. Larger defects need surgical repair early in life to prevent complications. Some defects are also closed surgically to prevent complications related to their location, such as damage to heart valves. Many people with small ventricular septal defects have normal, productive lives with few related problems.

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