Background: Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years. Methods: The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days). Results: Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively ( P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group ( P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively). Conclusion: Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.

A trial septal defect (ASD), the most prevalent congenital heart disease in adults, accounts for 5% to 10% of all congenital heart diseases.1 Although most patients are asymptomatic until adulthood, early diagnosis and treatment are crucial to prevent such possible sequelae as right-sided heart failure, pulmonary hypertension, and arrhythmia. Surgery is the gold standard in the treatment of secundum ASD, because its morbidity and mortality rates are very low, while postoperative functional capacity and survival rates are excellent in the long term. Although surgery is a low-risk and recommended treatment method, its risks include post-pericardiotomy syndrome, arrhythmia, pleural and pericardial effusion, the need for blood products, and scar formation. Percutaneous closure of ASD was first performed in 1976. It has been widely adopted over the subsequent decades because it is a low-risk method, implies a short hospital stay, has no need for blood products, and produces no scars.2 However, it can lead to life-threatening early and late sequelae that require emergency intervention. Early sequelae can include residual shunts, systemic and pulmonary device embolization, thromboembolism, superior vena cava and right-upper pulmonary vein compression, tricuspid or mitral valve compression, and arrhythmia. Late and life-threatening sequelae include free ruptures of the right and left atrial walls that cause cardiac tamponade, erosion of the ascending aorta, and aorta-atrial fistula formation. 2 Case ReportIn February 2013, a 22-year-old woman was admitted to our emergency department with sudden-onset dyspnea and subsequent syncope. In the initial examination, she was unconscious and in respiratory arrest. After cardiopulmonary resuscitation, she was intubated. Transthoracic echocardiography (TTE) revealed dense pericardial effusion, fibrin, and cardiac tamponade. The patient, in shock, underwent urgent operation.Intraoperative examination revealed rupture of the left atrial roof and noncoronary aortic sinus, caused by an atrial septal occluder (ASO) (Fig. 1). We placed a temporary pledgeted suture on the ruptured noncoronary sinus of the ascending aorta, to stop the bleeding through a very small perforation. After a standard bicaval cannulation, we initiated cardiopulmonary bypass. The right atrium was opened after aortic cross-clamping and antegrade delivery of blood cardioplegia. The ASO was then removed, and a temporary autologous pericardial patch was constructed for the ostial

No abstract

Left atrial aneurysm is an extremely rare anomaly, which can be associated with supraventricular arrhythmia, compression of coronary arteries, intracardiac thrombus, life-threatening systemic embolization, pulmonary venous obstruction, mitral valve insufficiency, and congestive heart failure. Herein, we report a four-year-old boy who had a giant aneurysm of the left atrium and severe mitral regurgitation. The aneurysm and mitral valve cleft causing severe mitral regurgitation were successfully repaired.

Background Postoperative thoracic aortic graft infection (TAGI) is a serious and potentially fatal complication. The classical approach is to replace the infected graft. However, this approach has a high mortality rate. Alternatively, treatment of TAGI without graft replacement can be performed Method Herein, we present a 72‐year‐old case with mediastinitis and graft infection after type A aortic dissection operation and successful treatment using omental flap coverage following vacuum‐assisted wound closure therapy without graft replacement. Conclusion The patient had an uneventful postoperative course and remains infection‐free to date.