PMC9949747_01
Post-operative image of the right anterolateral thoracotomy incision for left atrial appendage rupture closure with pleural and pericardial drain, and second intercostal space incision for insertion of Chitwood clamp.
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FIG1
ASD closure through right anterolateral thoracotomy (Figure 1) under cardiopulmonary bypass with double lumen tube intubation and single lung ventilation (left lung). A curvilinear inframammary incision was made over the right fifth intracostal space. Two drains were kept: one in the pleural cavity and another in the pericardial cavity (as seen above in Figure 1).
Conventional straight aortic cross-clamp
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FIG2
Chitwood aortic clamp. Image created by the authors
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FIG3
As the child was out of cardiopulmonary bypass (CPB), putting the child again on cardioplegia would have caused complications, hence it was decided to take the patient on CPB again after aortocaval recannulation and placing an aortic cross-clamp by inserting the Chitwood clamp (Figure 3) in the right second intercostal space in anterior axillary line after fibrillating the heart with a fibrillator temporarily without cardioplegia.
Cooley atraumatic vascular clamp. Image created by the authors
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FIG4
Then, the injured LAA was held with a Cooley's clamp (Figure 4) and the injury of about 0.5 cm of the LAA tip was repaired with prolene 5-0, and the LAA was tied with free silk 2-0.