Simsek Baran, Ozyuksel Arda, Saygi Murat, Basaran Murat
Department of Cardiovascular Surgery, Kolan Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Biruni University School of Medicine, Istanbul, Turkey.
Cardiol Young. 2024 Apr;34(4):765-770. doi: 10.1017/S1047951123003426. Epub 2023 Oct 12.
Pericardial tamponade, which increases postoperative mortality and morbidity, is still not uncommon after paediatric cardiac surgery. We considered that posterior pericardiotomy may be a useful and safe technique in order to reduce the incidence of early and late pericardial tamponade. Herein, we present our experience with creation of posterior pericardial window following congenital cardiac surgical procedures.
This retrospective study evaluated 229 patients who underwent paediatric cardiac surgical procedures between June 2021 and January 2023. A posterior pericardial window was created in all of the patients. In neonates and infants, pericardial window was performed at a size of 2x2 cm, whereas a 3x3 cm connection was established in elder children and young adults. A curved chest tube was placed and positioned at the posterolateral pericardiophrenic sinus. An additional straight anterior mediastinal chest tube was also inserted in every patient. Transthoracic echocardiographic evaluations were performed daily to assess postoperative pericardial effusion.
A total of 229 (135 male, 94 female) patients were operated. Mean age and body weight were 24.2 ± 26.7 months and 10.2 ± 6.7 kg, respectively. Eight (3.5%) of the patients were neonates where 109 (47.6%) were infants and 112 (48.9%) were in childhood. Fifty-two (22.7%) re-do operations were performed. Six (2.6%) patients underwent postoperative surgical re-exploration due to surgical site bleeding. Any early or late pericardial tamponade was not encountered in the study group.
Posterior pericardial window is an effective and safe technique in order to prevent both the early and late pericardial tamponade after congenital cardiac surgery.
心包填塞会增加小儿心脏手术后的死亡率和发病率，在小儿心脏手术后仍较为常见。我们认为，后心包切开术可能是一种有用且安全的技术，可降低早期和晚期心包填塞的发生率。在此，我们介绍我们在先天性心脏外科手术后创建后心包窗的经验。
这项回顾性研究评估了2021年6月至2023年1月期间接受小儿心脏外科手术的229例患者。所有患者均创建了后心包窗。在新生儿和婴儿中，心包窗的大小为2×2厘米，而在大龄儿童和青年中则建立了3×3厘米的连接。放置一根弯曲的胸管并将其置于后外侧心包膈窦处。每位患者还额外插入了一根直的前纵隔胸管。每天进行经胸超声心动图评估以评估术后心包积液。
总共229例（135例男性，94例女性）患者接受了手术。平均年龄和体重分别为24.2±26.7个月和10.2±6.7千克。其中8例（3.5%）为新生儿，109例（47.6%）为婴儿，112例（48.9%）为儿童期患者。进行了52例（22.7%）再次手术。6例（2.6%）患者因手术部位出血接受了术后手术再次探查。研究组未出现任何早期或晚期心包填塞情况。
后心包窗是预防先天性心脏手术后早期和晚期心包填塞的一种有效且安全的技术。
