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[Candida mediastinitis after double closure technique for repairing ventricular septal perforation]

K Ueyama1, M Koyama, K Otaki

  • 1Department of Cardiovascular Surgery, Asahikawa Red-cross Hospital, Asahikawa, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|March 14, 2009
PubMed

Insights

This case study details a patient who developed a ventricular septal perforation after acute myocardial infarction. Surgical repair using the Komeda-David method and double closure technique successfully closed the defect, leading to recovery.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Acute myocardial infarction can lead to serious complications.
  • Ventricular septal perforation (VSP) is a rare but life-threatening mechanical complication of myocardial infarction.

Observation:

  • A 69-year-old man presented with acute myocardial infarction.
  • A new systolic heart murmur appeared post-infarction, initially without detectable shunt.
  • Rapid cardiac deterioration, oliguria, and shock ensued, prompting repeat echocardiography.

Findings:

  • Repeat echocardiography revealed ventricular septal perforation in the anterior septum.
  • Emergency surgery successfully repaired the VSP using the Komeda-David infarct-exclusion technique with an equine pericardial patch and direct closure (double closure technique).
  • Fibrin glue was utilized to reinforce the septal patch closure.

Implications:

  • This case highlights the successful surgical management of a delayed ventricular septal perforation following myocardial infarction.
  • The combined infarct-exclusion and double closure technique, augmented with fibrin glue, proved effective in VSP repair.
  • Despite post-operative complications including Candida mediastinitis and pneumonia requiring further interventions, the patient achieved a favorable outcome with no residual shunt.

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