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Primary Infected Left Ventricular Pseudoaneurysm and the Use of Omental Flap
Giorgio Maria Aru1, Tad Kim2, Roberto Giorgio Aru1
1Department of Surgery, University of Mississippi, Jackson, Mississippi, USA.
Abstract:
A 55-year-old man with autoimmune deficiency syndrome presented with an infected left ventricular pseudoaneurysm and sepsis. The aneurysmectomy consisted of a Dor-style pericardial patch plus debridement of the abscess cavities. The infected pseudoaneurysm recurred, much larger, within five months due to persistent infected abscess cavities. The second repair was done without a Dor-style patch and with an omental flap. No recurrence has occurred one year after the second repair, but the patient has asymptomatic, partial gastric herniation inside the pericardium. This is the first description of a primary infected left ventricular pseudoaneurysm. The omental flap contributed to the successful treatment.
Insights
A patient with autoimmune deficiency syndrome developed a recurrent infected left ventricular pseudoaneurysm. An omental flap successfully treated the condition, preventing recurrence but causing minor gastric herniation.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Primary infected left ventricular pseudoaneurysm is rare, particularly in immunocompromised patients.
- Initial surgical management involved aneurysmectomy with a Dor-style pericardial patch and abscess debridement.
Observation:
- The patient presented with sepsis and an infected left ventricular pseudoaneurysm.
- A recurrence of the pseudoaneurysm occurred five months post-initial repair due to persistent abscesses.
Findings:
- A second surgical repair, excluding the pericardial patch and incorporating an omental flap, successfully eradicated the infection.
- One-year follow-up shows no pseudoaneurysm recurrence, though asymptomatic partial gastric herniation into the pericardium was noted.
Implications:
- This case highlights the omental flap as a viable and effective reconstructive option for complex cardiac infections.
- Successful management of primary infected pseudoaneurysms may require innovative surgical approaches beyond standard techniques.
- Further research into managing complications like gastric herniation after such procedures is warranted.
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