[Valve replacement after omentum flap for medicastinitis;report of a case]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Infectious Disease Management

Background:

• A 71-year-old female presented with heart failure secondary to severe aortic and mitral valve regurgitation.
• The patient had a history of acute aortic dissection treated with ascending aorta replacement 15 months prior, complicated by mediastinitis and graft infection.
• Previous management included an omentum flap operation to control the infection.

Observation:

• The patient required re-thoracotomy for redo ascending aorta replacement, aortic valve replacement, and mitral valve plasty due to persistent valve regurgitation.
• During the procedure, the omentum flap was carefully separated from cardiac structures using an ultrasonic scalpel.
• The omental tissue remained viable after separation.

Findings:

• The omentum flap was successfully preserved without damage to the heart or great vessels.
• The viable omental tissue was repositioned back into the mediastinal space post-operatively.
• The surgical team managed complex cardiac valve pathology in the context of prior infection and graft complications.

Implications:

• This case highlights the successful management of recurrent mediastinitis and graft infection in a complex cardiac surgery patient.
• Demonstrates the utility of omentum flap preservation and repositioning in redo thoracic procedures.
• Suggests that omentum flap viability can be maintained for potential reuse in managing complex thoracic infections and reconstructions.