Hörer Jürgen, Malcic Ivan, Schreiber Christian, Lange Rüdiger
Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Lazarettstrasse 36, D-80636 Munich, Germany.
Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):487-9. doi: 10.1510/icvts.2010.246009. Epub 2010 Dec 20.
The Norwood I operation, including placement of a shunt from the right ventricle to the pulmonary arteries, has been adopted by many surgeons for neonates with hypoplastic left heart syndrome. A three-year-old male who had undergone the Norwood I operation, and the Glenn operation, presented with a cervical pulsating tumor prior to the operation for total cavopulmonary connection. At the Glenn operation, the right ventricle to the pulmonary artery shunt was closed with a clip proximally, and the distal part was resected. Following the Glenn operation, the child had had recurrent deep sternal infections caused by Serratia marcescens. Cardiac catheterization showed a false aneurysm from the proximal shunt anastomosis. The bleeding after resternotomy was managed by initiating cardiopulmonary bypass via the groin vessels. Cerebral air embolies were prevented by systemic application of potassium, to achieve cardioplegic arrest during chest opening. The shunt was removed and the defect was closed. After the shunt was confirmed to be free from infection, a total cavopulmonary connection was performed after three days postoperatively. The case illustrates the management of retrosternal aneurysms during resternotomy in children.
诺伍德一期手术，包括放置从右心室到肺动脉的分流管，已被许多外科医生用于患有左心发育不全综合征的新生儿。一名三岁男性曾接受过诺伍德一期手术和格林手术，在进行全腔静脉肺动脉连接手术前出现了颈部搏动性肿瘤。在格林手术中，右心室至肺动脉分流管近端用夹子夹闭，远端部分切除。格林手术后，该患儿因粘质沙雷菌反复发生深部胸骨感染。心导管检查显示近端分流吻合处有假性动脉瘤。再次开胸术后出血通过经腹股沟血管启动体外循环进行处理。通过全身应用钾来预防脑空气栓塞，以便在开胸期间实现心脏停搏。分流管被移除，缺损被封闭。在确认分流管无感染后，术后三天进行了全腔静脉肺动脉连接手术。该病例说明了儿童再次开胸手术期间胸骨后动脉瘤的处理方法。
