Cardiac decompression after operation for congenital heart disease in infancy

Thoracic Compartment Syndrome Secondary to a Thoracic Procedure

“…Since then, almost 200 reported cases have appeared in the cardiothoracic literature. The pediatric literature reports 7,9 an incidence of delayed sternal closure due to the increasing complexity of surgery of 5.6% to almost 30% in the neonate. The survival rate in this group is also much lower than that in the adult population, with reports ranging from 50 to 64%.…”

“…The survival rate in this group is also much lower than that in the adult population, with reports ranging from 50 to 64%. 7,9 These figures are attributed to the use of extracardiac conduits and preoperatively dilated hearts with poor lung compliance due to excessive pulmonary blood flow.…”

“…6 With a review of the cardiac literature, four major causes of prolonged open sternotomy have been identified. 4,5,7 The number one identified reason was coagulopathy with uncontrolled bleeding. Our patient required treatment with multiple blood products, but not to the degree described in the literature.…”

“…However, the diuresis of patients who may actually be intravascularly underresuscitated can prove to be difficult and harmful. 7 Furnary et al 6 found that mediastinitis was much more common in the delayed sternal closure population when bleeding was the primary indication for the open chest. Also, the reported rates of mediastinitis in the general cardiothoracic population of 0.15 to 5% are consistent with the 4 to 6% incidence reported in the literature on prolonged open sternotomy.…”

Nursing Considerations for Children Undergoing Delayed Sternal Closure After Surgery for Congenital Heart Disease

“…9 Gangahar et al 11 Shore et al 7 Bjork et al 12 Jogi and Werner 13 Kay et al 14 Odim et al 15 Ziemer et al 6 Elami et al 16 Hakimi et al 17 Alexi-Meskishvili et al 18 Iyer et al 19 Tabbutt et al 20 McElheinney et al 21 McElheinney et al 5 Amato 22 Walker et al 23 Main et al 24 Samir et al 25 Riphagen et al 10 lifted off of the heart with some form of traction or splinted from touching the heart ( Figure 2) by using surgical tools such as rib spreaders, stents, 16,23 or struts. 20 The splinting device is placed between the sternal edges before the sterile dressing is applied.…”