Seguin J R, Frapier J M, Colson P, Chaptal P A
Thoracic and Cardiovascular Surgery Unit, C.H.U. Hôpital Saint Eloi, Montpellier, France.
J Thorac Cardiovasc Surg. 1992 Sep;104(3):748-51.
The trend toward early operation for acquired ventricular septal defects exposes the patient to major perioperative bleeding and residual shunt because of the fragility of the recently necrosed myocardium. To reduce these complications we have used a fibrin sealant to reinforce the cardiac tissues in addition to the usual closure of the defect with a Dacron patch through a left ventricular septum around the defect, area. During cardiac arrest fibrin sealant is applied on the ventricular septum around the defect, between the septum and the patch, and on the edges of the ventriculotomy. This technique was used in three patients (mean age 68.2 years) operated on for an acquired ventricular septal defect within 4 days of the infarction and within 24 hours of the occurrence of the defect. Low postoperative bleeding, absence of recurrent shunt, and good ventricular function indicated satisfactory surgical result in all three patients. We suggest that the use of fibrin sealant during operations for acquired ventricular septal defects, by reinforcing the necrotic and fragile tissues, may reduce perioperative bleeding and assure a more solid implantation of the patch.
由于近期坏死心肌组织的脆弱性，后天性室间隔缺损的早期手术趋势使患者面临围手术期大出血和残余分流的风险。为了减少这些并发症，除了通过围绕缺损区域的左心室间隔用涤纶补片常规闭合缺损外，我们还使用了纤维蛋白密封剂来加固心脏组织。在心脏停搏期间，将纤维蛋白密封剂应用于缺损周围的室间隔、间隔与补片之间以及心室切开边缘。该技术用于3例后天性室间隔缺损患者（平均年龄68.2岁），手术在梗死4天内且缺损发生24小时内进行。术后出血少、无复发性分流且心室功能良好，表明这3例患者手术结果令人满意。我们建议，在后天性室间隔缺损手术中使用纤维蛋白密封剂，通过加固坏死和脆弱组织，可减少围手术期出血并确保补片植入更牢固。
