Sasidharan Baiju, Moideen Ijaz, Warrier Girish, Prabhu Anil, Koshy Sajan, Nair Suresh Gangadharan, Gururaja Rao Suresh, Shivaprakasha Krishnanaik
Division of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Elamakkara P.O., Kochi 682026, Kerala, India.
Interact Cardiovasc Thorac Surg. 2006 Jun;5(3):272-4. doi: 10.1510/icvts.2005.118752. Epub 2006 Feb 27.
We report an unusual complication following closure of atrial septal defect through right limited posterior thoracotomy.
An eight-year-old girl underwent closure of atrial septal defect through right limited posterior thoracotomy. She developed cardiac herniation in the early post-operative period following a tension pneumothorax on the left side, while recovering in the intensive care unit.
Cardiac herniation was promptly recognized, albeit subtle hemodynamic changes, and was reduced through re-operation.
Liberal use of pericardium for closure of intra-cardiac defects results in a gap in the pericardial sac. Posterior thoracotomy approach for closure of atrial septal defect has a higher propensity for cardiac herniation owing to the small size and postero-lateral location of the pericardial defect. Recognition and early treatment of cardiac herniation is important since it can mimic cardiac tamponade. Cardiac herniation can be avoided either by enlarging the pericardial defect or by closing it with a prosthetic patch.
我们报告了一例通过右后外侧小切口闭合房间隔缺损后出现的罕见并发症。
一名8岁女孩通过右后外侧小切口进行房间隔缺损闭合术。术后早期，她在重症监护病房恢复过程中，因左侧张力性气胸出现了心脏疝。
尽管血流动力学变化不明显，但心脏疝仍被及时发现，并通过再次手术得以复位。
大量使用心包来闭合心脏内缺损会导致心包囊出现缺口。由于心包缺损小且位于后外侧，经后外侧开胸途径闭合房间隔缺损时心脏疝形成的倾向更高。认识到心脏疝并早期治疗很重要，因为它可能类似心脏压塞。通过扩大心包缺损或使用人工补片闭合心包缺损，可以避免心脏疝的发生。
