Clinical Anatomical Study on Cardiac Surgical

Abstract: Objective To design and evaluate the cardiac operative minor approaches, and provide theoretic reference for the clinical utilization of minor approaches. Materials & Methods Thirty formalin-preserved adult cadavers and ten free formalin-preserved adult hearts were included in this study. Fifteen X-ray images of the adults who had no cardiac problems were observed, and thirty-five cardiac surgical patients were also studied. After the anterior structures of the chest wall of ten cadavers were observed, several minor approaches were designed according to the characteristics of these structures. Consequently, these minor approaches were imitated in thirty cadavers, and were evaluated systematically from the aspects of cosmetic effect, traumatic extend, and exposing effect. The exposing of mitral valve through the routes of the heart itself were studied in various minor approaches imitated in five cadavers. The feasibility of the approach posterior to ascending aorta was also studied. The X-ray images of fifteen adults who have no cardiac problems, two mitral valvular surgical patients, and one ventricular septum defect patients were studied, so that the possibilities of evaluating the positions of minor approaches using X-ray examination could be attempted. The clinical experience of four different cardiac operative approaches, i.e. median sternotomy, inferior partial sternotomy, right anteriolateral thoracotomy, and right anteriolateral minor thoracotomy, were summarized ultimately. Results Pectoralis major has a close relationship with the designing of minor approach, while pectoralis minor has not. The main nutrient arteries to the structures on the anterior thoracic wall are internal thoracic artery and its branches. Using internal thoracic artery as a pedicle, several novel minor approaches could be designed, which include partial median stemotomy, parastemal approach, anteriolateral thoracotomy, and the special minor approaches containing the vascularized complicated tissue flap. Minor approaches are shorter but less cosmeticly accepted than traditional approaches. The minor approaches also have relatively poor exposing effects. Approach posterior to ascending aorta is an excellent approach for the patients suffering both mitral valve and aortic valve problems. Using X-ray images, the relationship between the operative sites and the structures on the chest wall could be evaluated approximately. In clinic, the similar results have been made. Conclusions The novel minor approaches designed in this study according to the characteristics of the anterior thoracic wall are practical. The cosmetic results and the traumatic effects of minor approaches are superior to the traditional approaches, but minor approaches have relatively poor exposing effects. The choosing of minor approach should be determined by the characteristics of the approach itself and the cardiac defects. For the patients suffering both mitral valve and aortic valve problems, approach posterior to ascending aorta is a reasonable approach. X-ray examination can evaluate the approximate spatial relationship of cardiac operative sites and the chest wall structures. The clinical experiences proved that the cosmetic results of the skin incision of the minor approaches are better than that of median sternotomy and right anteriolateral thoracotomy, while the trauma is less than that of the two traditional approaches. Unfortunately, after accomplishing the cannulation of cardiopulmonary bypass, the operative field was possessed by the tube…
Key words: cardiac surgery; minor approach; clinical anatomy

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