Cartier R, Diaz O S, Carrier M, Leclerc Y, Castonguay Y, Leung T K
Department of Cardiovascular Surgery, Montreal Heart Institute, Quebec, Canada.
J Thorac Cardiovasc Surg. 1993 Dec;106(6):1036-9.
Mediastinitis-related right ventricular rupture is an unusual but potentially life-threatening complication of cardiac operations. Between January 1981 and December 1990, a total of 10,182 patients underwent heart operations for ischemic, valvular, and congenital heart disease at the Montreal Heart Institute. Forty-eight patients (0.5%) had postoperative mediastinitis necessitating surgical exploration and sternal debridement. The mediastinum was left open for daily irrigation with povidone-iodine and chest reconstruction was postponed. During treatment, seven patients (0.07%) had right ventricular rupture necessitating immediate surgical repair. All had ischemic heart disease before the operation. There were five women and two men, ages ranging from 52 to 65 years (mean 58 +/- 5 years). Surgical repair consisted of autologous patch covered with omentoplasty assisted with cardiopulmonary bypass. Two patients died, one during the operation of massive hemorrhage and the other 10 days after the operation of uncontrolled sepsis. Five patients survived 2 to 29 months (mean 23 +/- 10 months) after right ventricular rupture, with an overall survival of 71%. Obesity was more frequent in the patients with right ventricular rupture and was found to be a significant risk factor (multivariate analysis, p < 0.05, relative risk 3.22). Histologic examination of the right ventricle in the patient who died after a successful repair revealed fatty infiltration of the right ventricular wall. This may have predisposed the patient toward ventricular rupture. In conclusion, right ventricular rupture, an unusual event in heart surgery, is related to open sternal debridement. Favorable outcome of this complication depends on immediate surgical management, autologous repair, and the use of omentoplasty.
纵隔炎相关的右心室破裂是心脏手术中一种罕见但可能危及生命的并发症。1981年1月至1990年12月期间，共有10182例患者在蒙特利尔心脏研究所接受了针对缺血性、瓣膜性和先天性心脏病的心脏手术。48例患者（0.5%）术后发生纵隔炎，需要进行手术探查和胸骨清创术。纵隔敞开，每日用聚维酮碘冲洗，胸部重建推迟。治疗期间，7例患者（0.07%）发生右心室破裂，需要立即进行手术修复。所有患者术前均患有缺血性心脏病。其中5名女性，2名男性，年龄在52至65岁之间（平均58±5岁）。手术修复包括自体补片覆盖，并在体外循环辅助下进行网膜成形术。2例患者死亡，1例在手术中因大出血死亡，另1例在术后10天因败血症失控死亡。5例患者在右心室破裂后存活了2至29个月（平均23±10个月），总体生存率为71%。右心室破裂患者中肥胖更为常见，且被发现是一个显著的危险因素（多因素分析，p<0.05，相对危险度3.22）。成功修复后死亡患者的右心室组织学检查显示右心室壁有脂肪浸润。这可能使患者易发生心室破裂。总之，右心室破裂是心脏手术中一种罕见的情况，与胸骨清创术有关。这种并发症的良好预后取决于立即的手术处理、自体修复以及网膜成形术的应用。
