Yu Y F
General Hospital, People's Liberation Army, Beijing.
Zhonghua Wai Ke Za Zhi. 1992 Dec;30(12):749-50, 780.
The authors reported 23 cases of re-open heart surgery in 1473 patients with congenital heart disease treated surgically in the last ten years. The incidence was 1.6%. In 13 cases of the 23 re-open heart procedure was performed before closing the chest during the operation because of missed diagnosis in 5, incomplete correction of the anomaly in 5, and injure to important organ in 3. All of the 13 patients were recovered and discharged. Of the 23 cases re-open heart surgery was performed during the early postoperative period in 8 cases, including 4 cases of misdiagnosis, and 4 incomplete correction. 1 patient with VSD had still residual ventricular septal shunt post reintervention and died of circulatory failure. Re-open heart surgery was performed during the late postoperative period in 2 of the 23 cases. There was 1 missed diagnosis, and another incomplete correction. 1 patient died of massive bleeding during the reoperation. The anthers pointed out that accurate diagnosis and error-free operation is of most importance in avoiding re-open heart surgery. Through exploration to the heart after resuscitation during the operation and positive re-opening of the heart when necessary were emphasized. Indication of early and late postoperative re-open heart surgery and methods to prevent its complication were listed.
作者报告了在过去十年接受手术治疗的1473例先天性心脏病患者中，有23例进行了再次心脏手术。发生率为1.6%。在23例再次心脏手术中，有13例是在手术过程中关胸之前进行的，原因包括误诊5例、畸形矫正不彻底5例、重要器官损伤3例。这13例患者均康复出院。在23例中，有8例在术后早期进行了再次心脏手术，其中包括误诊4例、矫正不彻底4例。1例室间隔缺损患者再次干预后仍有残余室间隔分流，死于循环衰竭。23例中有2例在术后晚期进行了再次心脏手术。1例误诊，另1例矫正不彻底。1例患者在再次手术时死于大出血。作者指出，准确诊断和无误操作对于避免再次心脏手术最为重要。强调了术中复苏后对心脏进行探查以及必要时积极再次开胸。列出了术后早期和晚期再次心脏手术的指征以及预防其并发症的方法。
