Explore Dr. Sajan Koshy’s innovative limited right posterior thoracotomy technique used to close atrial septal defects in young female patients—offering cosmetic benefits and excellent clinical outcomes.

Why This Matters

Atrial septal defects (ASD) are among the most common congenital heart defects in children. Traditionally, ASD repair requires a full sternotomy—an incision through the breastbone—which can be traumatic and leave prominent scars. In 2002, Koshy and his colleagues introduced a limited thoracotomy approach to change that narrative (pubmed.ncbi.nlm.nih.gov, researchgate.net).

Study Overview

• Journal & Authors: Asian Cardiovascular & Thoracic Annals; Gopalraj S Sunil, Sajan Koshy et al. (pubmed.ncbi.nlm.nih.gov)
• Patients: 75 pre-pubescent females aged 3–13 (median age: 7; weight: 10–46 kg)
• Timeline: July 1999 – May 2001
• Procedure: Closure of ASD via limited right posterior thoracotomy instead of full sternotomy

Key Outcomes

• Ventilation time: Median 13.3 hours
• Hospital stay: Median 6 days
• Follow-up: 7–32 months (average 15); nearly all patients had smooth recoveries
• Cosmesis: Incision hidden under scapula, no breast development interference; no movement restrictions (pubmed.ncbi.nlm.nih.gov, academic.oup.com)

Surgical Technique Highlights

• Patient positioning: Left lateral decubitus with chest elevated
• Incision site: Curved incision around the scapula avoiding major muscle disruption
• Cannulation: Standard aortic and caval cannulation performed within the field
• CPB arrest: Eight patients had fibrillatory arrest; others had cardioplegia

Advantages

• Comparable operative safety and recovery
• Cosmetic outcome far superior to sternotomy
• Maintenance of chest wall and breast growth
• No need for specialized tools—can be adopted widely (journals.sagepub.com, researchgate.net, link.springer.com)
  

Links & References

• About Dr. Sajan Koshy
• Patient Testimonials
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• Asian Cardiovascular & Thoracic Annals via PubMed (pubmed.ncbi.nlm.nih.gov, annalsthoracicsurgery.org)
• Amrita Institute of Medical Sciences (affiliation)