ABSTRACT
A case of congenital diaphragmatic eventration on the right and central tendinous portion with accessory hepatic lobe causing direct compression of the right heart is presented. We have performed the video assisted thoracoscopic plication of the right hemidiaphragm and eliminated the mass effect of the accessory hepatic lobe.
Subject(s)
Diaphragmatic Eventration , Heart , ThoracoscopyABSTRACT
We retrospectively reviewed a series of 20 patients treated with delayed sternal closure during a 5-year period from 1991 to 1996. Of the 2675 patients with cardiovascular surgery 20 underwent this procedure. Male and female ratio was 11:9, mean age was 6.4 months(range 7 days to 5 years). The indications included unstable hemodynamic profiles after open heart surgery due to myocardial edema and poor lung compliance(15), necessity of mechanical ventricular assist device due to weaning failure(3), and hypoxia after PAB(2). Sternum was closed at a mean interval of 102(range 4 to 213) hours after operation. During delayed sternal closure, central venous pressure was elevated(p<0.05). Mediastinitis and other wound problems did not occur. Sepsis developed in 2 patients and microorganism was confirmed in one of the two patients. Five patients died(mortality 25%). And two of 15 discharged patients died during follow-up period. Cumulative survival rate was 65.0% at 12 months and also 65.0% at 24 months.(Standard error was 10.7%) Delayed sternal closure is considered to be a good method to decompress the hemodynamically compromised heart. Without that, it is not feasible to come off bypass or to decompress the heart. Of course, careful selection of the indication is imperative.