Abstract
Heart distension after the open heart surgery was treated by emergent sternum separating splint and secondary sternal closure in 2 patients of tetralogy of Fallot. Total correction of the anomaly was done using surfacecooling deep hypothermia and cardiopulmonary bypass. A technique of secondary sternal closure is described. Case 1 was weaned off cardiopulmonary bypass without difficulty. Eight hours after operation, the patient became hypotensive and cyanotic. In emergency, sternum was opened and the cardiac function recovered. The sternum remained open by splint with use of the plastic chest drain and steel wire. Eighty days after the operation, sternal splint was removed and the sternum was closed successfuly. Case 2 was complicated by refractory hypotension due to heart distension during radical operation. Therefore, the sternum remained to be separated and only the skin was sutured. Stable circulation was maintained by administration of noradrenalin. However, thirty-six hours after operation, the patient's condition was deteriorated. Sternum was splinted open using the dental resin plate. After that, patient recovered well. Thirty-eight days after the operation, the resin splint was removed and the sternum was closed successfuly. Two patients survived after delayed sternal closure for heart distension. Delayed sternal closure was useful for distension of heart and maintain a good circulation.
