A 4-year-old boy who had been followed for a ventricular septal defect (VSD) and remained asymptomatic had a follow-up echocardiogram that showed enlargement of his cardiac chambers secondary to a left-to-right shunt and a gradient across the left ventricular outflow tract (LVOT), with the development of multiple hypertrophied muscle bundles in the right ventricle, creating a double-chambered morphology. 

Through a minimally invasive right axillary thoracotomy and under aorto-bicaval cardiopulmonary bypass, the hypertrophied muscle bundles in the right ventricular outflow tract (RVOT) were divided, followed by bovine pericardial patch closure of the VSD. An aortotomy was then created, and the subaortic membrane was resected in its entirety.  

The patient had an uneventful postoperative course, received no transfusion, and was discharged on the third postoperative day. He continued to do well during his follow-up, with no RVOT or LVOT gradient, a competent aortic valve, and no significant residual shunts. The right axillary thoracotomy continues to be the authors’ preferred approach for infants and children, even those with multiple heart defects. It is associated with superior cosmetic results, faster recovery, and a shorter hospital stay compared to standard median sternotomy. 

References

1. Said SM, Greathouse KC, McCarthy CM, Brown N, Kumar S, Salem MI, Kloesel B, Sainathan S. Safety and Efficacy of Right Axillary Thoracotomy for Repair of Congenital Heart Defects in Children. World J Pediatr Congenit Heart Surg. 2023 Jan;14(1):47-54
2. Mashadi AH, Alomair M, Said SM. Minimally invasive resection of a subaortic membrane via a vertical right axillary thoracotomy in a child. Multimed Man Cardiothorac Surg. 2025 May 6;2025. doi: 10.1510/mmcts.2024.138.

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