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[A case report of mycotic false aortic aneurysm associated with aortic regurgitation]
Abstract:
The patient was 63-year-old man, who underwent patch closure of VSP 37 days after onset. LVAD was required for weaning from CPB. Mediastinitis occurred after LVAD was removed. The mediastinum was irrigated using diluted antibiotics through the retrosternal drain. He discharged on 79th day postoperatively. False aortic aneurysm and marked AR was pointed out by cineangiography and enhanced CT scan two years after operation. AVR was performed through right thoracotomy, because false aortic aneurysm invaded the sternum. The aneurysmal wall was repaired with patch. Postoperatively, peritoneal dialysis was performed for two days. Flail chest made difficult weaning from the respirator. He died 11 days postoperatively due to respiratory failure. There remains the possibility that mediastinitis resulted in false aortic aneurysm and AR. It was esseutial to remove the foreign materials placed on the aorta for eradication of infection.
Insights
A 63-year-old man developed mediastinitis after aortic surgery, leading to a false aortic aneurysm and aortic regurgitation. Prompt removal of foreign materials is crucial for infection eradication.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Device Complications
Background:
- A 63-year-old male patient underwent patch closure for a ventricular septal defect (VSP).
- Cardiopulmonary bypass (CPB) necessitated the use of a left ventricular assist device (LVAD).
Observation:
- Mediastinitis developed post-LVAD removal, treated with antibiotic irrigation via a retrosternal drain.
- Two years post-operation, cineangiography and CT revealed a false aortic aneurysm and severe aortic regurgitation (AR).
Findings:
- The false aortic aneurysm invaded the sternum, requiring aortic valve replacement (AVR) via right thoracotomy and aneurysmal wall repair.
- Post-AVR complications included respiratory failure secondary to flail chest, leading to death.
Implications:
- Mediastinitis may be a precursor to false aortic aneurysms and AR, highlighting the importance of foreign material removal for infection control.
- Aggressive management of post-surgical infections is critical to prevent severe cardiovascular complications.