Résumé
A 43-year-old woman underwent aortic valve replacement for aortic regurgitation causing aortitis syndrome. The postoperative course had been uneventful and inflammation was controlled by steroid therapy. She developed a moderate degree of dyspnea with cardiomegaly. Two years after the first aorta valve replacement (AVR), severe aortic regurgitation was observed on both echocardiography and aortography. Dehiscence of the prosthetic valve was suspected and an emergency operation was performed. To secure the reimplanted prosthetic valve, we applied the technique of passing felt-pledgeted sutures through the aortic wall in the vicinity to the right coronary cusp and the noncoronary cusp and others through the left coronary cusp with everting mattress sutures. The postoperative course of the second AVR has been uneventful for two months. Since prosthetic valve detachment can occur even if inflammation of aortitis is well controlled, strict management of inflammation is recommended for a prolonged period to prevent reccurence of aortitis and subsequent valve dehiscence.
Résumé
The cases of neonates and infants who underwent successful delayed sternal closure (DSC) using silastic rubber after open heart surgery were reviewed. The indication for DSC was cardiac dilatation with tamponade-like behavior upon attempted sternal closure in all. In 7 of 10 cases, DSC were possible within 4 days after operation. There were statistical decrease in heart rate (HR), left atrial pressure (LAP), cardiothoracic ratio (CTR) and inspiratory oxygen concentration of the respirator at the time of DSC compared to those in the early postoperative period. None of the patients had mediastinitis or other severe infection in the postoperative course. One patient each died of progressive pulmonary venous obstruction and of non-cardiac disease late postoperatively and 8 patients are long-term survivors. It is concluded that DSC is recommended whenever there is any hemodynamic deterioration due to attempted sternal closure following open heart surgery in infancy as it could be safely performed within 3 to 4 days after operation without any complication.