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Summary

A rare cardiac surgery complication involving median sternotomy led to mediastinitis and fatal right ventricle rupture due to adhesions. This case highlights unusual risks in sternotomy patients.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Infectious Disease

Background:

  • Mediastinitis and major bleeding are known, high-mortality complications of cardiac surgery via sternotomy.
  • Median sternotomy is a common surgical approach for cardiac procedures.

Observation:

  • A 71-year-old male developed sternal dehiscence 7 days post-coronary artery bypass grafting.
  • Post-discharge, he presented with purulent sternal wound drainage, diagnosed as mediastinitis.
  • Following surgical intervention for mediastinitis, a tear in the right ventricle was discovered, leading to exsanguination.

Findings:

  • Autopsy revealed adhesions between the posterior sternum and the right ventricle wall.
  • Microscopic examination showed fatty infiltration at the myocardial rupture site.
  • The fatal outcome was attributed to right ventricular rupture secondary to mediastinitis and adhesions.

Implications:

  • This case underscores the potential for unique and catastrophic complications following median sternotomy.
  • Investigating the microbial etiology of mediastinal infections is crucial.
  • Understanding the mechanisms of injury is vital for preventing similar fatal outcomes in sternotomy patients.