The Annals of Thoracic Surgery, Vol 31, 433-436, Copyright © 1981 by The Society of Thoracic Surgeons
Repair of left atrial abnormalities in children by the superior approach
AA Richi, RM Sade, MG May and AR Hohn
We have used the superior approach through the dome of the left atrium to
repair cardiac lesions in the left atrium in 15 children ranging from 3
months to 17 years old. The single hospital death occurred in a
16-month-old infant with levo (L) transposition of the great arteries,
Ebstein's malformation of the left atrioventricular valve, and ventricular
septal defect. Exposure of the intraatrial structures was excellent, injury
to adjacent cardiac structures did not occur, and hemorrhage from the left
atrial suture line was not a problem. Though a few transient arrhythmias
were seen, all survivors are in sinus rhythm without evidence of sick sinus
syndrome, except 1 patient in whom atrial flutter associated with
cardiomyopathy developed 1 year after operation. The excellent surgical
exposure obtained of the interior of the left atrium and the absence of
important complications related to the incision cause us to recommend this
approach in children.
