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Texas Heart Institute Journal
|April 30, 2016
Summary
A rare case of delayed prosthetic cardiac infection by Clostridium difficile occurred 10 years after surgery. This infection led to a left ventricular pseudoaneurysm and required patch removal and apex repair.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Device Infections
Background:
- A 69-year-old man with ischemic cardiomyopathy underwent coronary artery bypass grafting with a Dor procedure as part of the Surgical Treatment for Ischemic Heart Failure (STICH) trial.
- Initial presentation was concerning for left ventricular pseudoaneurysm, but surgical exploration revealed empyema without pseudoaneurysm.
Observation:
- Purulent material and empyema were found, communicating into the pericardial space.
- An epicardial patch from the prior surgery was not initially suspected as the source of infection and was left in place.
Findings:
- The patient later presented with hemorrhagic shock due to a left ventricular pseudoaneurysm with ventricular apex disruption.
- The previously placed epicardial felt-and-Dacron patch was identified as infected with Clostridium difficile and was subsequently removed.
- The left ventricular apex was repaired.
Implications:
- This case highlights an extraordinarily uncommon delayed presentation of prosthetic cardiac material infection.
- Clostridium difficile bacteremia seeding prosthetic material, leading to pseudoaneurysm formation, is a rare but severe complication.