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[Infection of an anastomosis: a formidable complication of operations for aortic coarctation]
Insights
Post-coarctation repair infections can lead to aortic complications like mycotic aneurysms and rupture. Close patient monitoring and prompt diagnosis are crucial for preventing fatal outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Infectious Diseases
Background:
- Surgical repair of isthmic coarctation of the aorta is performed using various techniques.
- Postoperative complications, including infection, can arise after aortic coarctation repair.
Observation:
- Four pediatric patients (12-day-old to 14-year-old) developed operative field infections and septicemia post-coarctation repair.
- Aortic rupture occurred in one neonate within days, while three others developed mycotic false aneurysms, leading to one death and two successful reoperations.
Findings:
- Infections following aortic coarctation repair can lead to severe complications such as mycotic aneurysms and aortic rupture.
- Early detection through vigilant monitoring and diagnostic imaging is critical for managing these complications.
Implications:
- Patients require close post-operative follow-up for at least one month to detect late complications.
- Suspicion of fever and characteristic aortic dilatation necessitates prompt investigation using radiography, echocardiography, or angiocardiography.
- Surgical intervention, including aorto-aortic deviation, is essential for managing aortic complications and preventing catastrophic rupture.
Abstract:
One 12 day newborn, a 2 year old infant and two children aged 10 and 14, operated for isthmic coarctation of the aorta by three different surgical techniques (resection-anastomosis, angioplasty with an autograft, prosthetic graft) suffered infection of the operative field, resulting in septicemia (3 staphylococcal and 1 yeast infections). The aorta ruptured after 4 days, before any collection of pus in the newborn but a mycotic false aneurysm developed in the three other patients: this was the cause of death by aortic rupture during the 5th postoperative week in one case but was diagnosed and operated successfully in the other two, 13 and 54 days after their first operation. These complications are well known. Therefore, these patients should be closely followed up for at least one month. The occurrence of pyrexia, even slight or late, should be treated with suspicion. Characteristic dilatation of the part of the aorta operated on should be actively looked for by simple radiography, 2D echocardiography and, when in doubt, right heart angiocardiography. The diagnosis is a surgical emergency: the safest technique consists in initially establishing an aorto-aortic deviation by a right sided approach followed by exclusion of the lesion. Surgery is the only means of preventing catastrophic rupture of the aorta.