Cardiac Compression due to Closure of the Median Sternotomy in Open Heart Surgery

Open chest management after cardiac operations: outcome and timing of delayed sternal closure

“…Riahi et al [1] were the first to point out the problem of cardiomediastinal disproportion in 1975. They used upward traction on the closed chest, which would then be increasingly weaned as the patient improved.…”

Delayed sternal closure following open heart surgery in children

“…[3] Although an increasing volume of younger patients undergoing open heart surgery has made this application more valuable in the last two decades, the first clinical case was published back in 1975. [4] The same indications for DSC application in adults are also applicable in children. These can be summarized as inadequate hemostasis that is likely to cause tamponade upon closure, the need for ECMO access or similar life support systems, and pulmonary problems.…”

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

“…5 This ongoing state of cardiac compression can cause a state of progressive low cardiac output that leads to hemodynamic instability and compromise. This clinical situation of low cardiac output has been described in the adult and pediatric literature by different terms: typical tamponade, 6 atypical tamponade, 7 tight mediastinal syndrome, 8 and cardiac compression. 9 Clinical surgical experience and documented medical literature support leaving the sternum open postoperatively for the following clinical situations: hemodynamic instability, myocardial edema, cardiac dilatation, intractable bleeding and coagulopathy, dysrrhythmias, respiratory compromise, and mediastinal placement of a circulatory assist device.…”

“…8 In 1978, Ott et al 9 reported one of the first pediatric cases of DSC, in a 2-month old who had undergone surgical repair of d-transposition of the great vessels. Since then, the use of open sternum followed by DSC in neonates and children has been well documented to be helpful in managing these critically ill children in the early postoperative phase of recovery after surgical palliation or repair of CHD.…”