1/29. Treatment of mediastinitis arising after replacement of the ascending aorta.mediastinitis due to graft infection is a serious and potentially lethal complication associated with replacement of the ascending aorta. We present the case of a 67-year-old man with this condition for the aneurysm and chronic dissection. mediastinitis and sepsis were diagnosed and debridement, irrigation with povidone solution and omental transposition were performed successfully. Continuous closed irrigation prior to omental transposition without replacement of the infected graft is useful for treating mediastinitis after ascending aortic or arch replacement.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/29. aorta-cutaneous fistula as a rare complication of localized chronic mediastinitis.A 35-year-old man was admitted 5 years after congenital heart surgery complicated by Staphylococcus aureus and a cutaneous fistula located at the left fourth intercostal space. He was febrile (40 degrees C), suffering from sternal pain and suppuration from the old fistula. During examination arterial blood suddenly discharged from the fistula, so that surgery was immediately instituted. An infected Dacron tube implanting on the ascending aorta for a central aorto-pulmonary shunt was at the origin of a false aneurysm: this had led to the repeat formation of an aorta-cutaneous fistula and outbreak of external bleeding.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
3/29. Poststernotomy mediastinitis treated by rectus muscle flap plugging.The current standard treatment of mediastinitis following median sternotomy is radical sternal curettage and plugging of the anterior mediastinal dead space with muscle flap or omentum. This paper will report our experience with a pediculated flap of the rectus muscle after mediastinal irrigation and drainage. The patient was a 75-year-old man diagnosed as having aortic arch aneurysm. The patient underwent a total aortic arch replacement with the bovine-collagen sealed vascular prosthesis (Hemashield). As an early postoperative complication, he was diagnosed with mediastinitis which was the result of infection of the drainage fluid. Mediastinal curettage and plugging of the rectus muscle flap was successfully performed. Without recurrence of infection, the wound healed completely. We conclude that early curettage and rectus muscle flap plugging are the most effective treatment of the poststernotomy mediastinitis.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
4/29. Interposition of hydroxyapatite ceramic stents alternative to delayed sternal closure.Ascending and hemiarch replacement surgery for an acute Stanford type A dissection in association with a previous type B dissecting aneurysm was performed on a 58-year-old female patient. However, sternal closure could not be performed after surgery due to hemodynamic deterioration. Even four weeks after the operation, sternal closure was impossible due to advanced adhesion around the mediastinum caused by mediastinitis. Therefore, hydroxyapatite ceramic spacers, which have osteogenesis and ossification characteristics, were interposed between the split sternum as stents to avoid further surgery.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
5/29. Resection of ascending aorta aneurysm in redo surgery through an anterior thoracotomy.Resection of an aneurysm of the distal ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion though a right anterior thoracotomy. Seven years before, the patient had undergone orthotopic cardiac transplantation and had required pectoral muscle plasty to heal an infectious mediastinitis. This new approach avoided a potentially hazardous sternotomy and allowed successful resection of the aneurysm and reconstruction of a thrombosed innominate vein.- - - - - - - - - - ranking = 6keywords = aneurysm (Clic here for more details about this article) |
6/29. Successful treatment of MRSA mediastinitis after aortic arch replacement.An aortic arch graft replacement was successfully performed for a true aneurysm on the distal aortic arch. However, methicillin-resistant staphylococcus aureus (MRSA) mediastinitis occurred after surgery. Following reoperation for debridement and irrigation of the mediastinal space, antibiotics were administered and continuous irrigation of mediastinal space with saline containing appropriate antibiotics and intermittently short duration irrigation with a large quantity of saline containing popidone-iodine were carried out with good results. This paper presents the successful treatment of mediastinitis after replacement of the aortic arch without removing the graft, followed by a brief review of the literature regarding infection of prostetic grafts for the thoracic aorta.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
7/29. Case report: right subclavian artery pseudoaneurysm due to perforation of esophageal cancer.A 51-year-old man presented with massive hematemesis. Perforation of upper esophageal cancer, which had already occurred at least six days earlier, progressed to upper mediastinitis. The mediastinitis contiguous to the right subclavian artery was considered to have caused a pseudoaneurysm. Rupture of the pseudoaneurysm into the esophagus resulted in massive hematemesis. Both enhanced computed tomography and angiography were diagnostic for the pseudoaneurysm. Transluminal endovascular stent-grafts placement was successful in preventing subsequent hemorrhage.- - - - - - - - - - ranking = 139.68651041191keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
8/29. Transesophageal two- and three-dimensional echocardiographic diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture.Two- (2-D) and three-dimensional (3-D) transesophageal echocardiography (TEE) were useful in making the diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture in an elderly patient presenting with mediastinitis and worsening heart failure following coronary artery bypass graft surgery. The diagnosis was not suspected clinically. Three-dimensional TEE served to increase the confidence level with which the diagnosis of this combined lesion was made. Additionally, 3-D TEE proved superior to 2-D TEE in assessing the size of the left ventricular rupture site.- - - - - - - - - - ranking = 99.776078865648keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
9/29. False aneurysm of the ascending aorta concomitant with chronic mediastinitis after tube graft replacement in octogenarian.An 81-year-old man developed impending rupture of a false aneurysm of the ascending aorta concomitant with chronic mediastinitis lasting for 10 years after tube graft replacement. He had undergone various infection-related mediastinal surgical procedures. He was successfully treated by debridement of infected tissues, patch repair of the false aneurysm, and transposition of the right latissimus dorsi muscle flap. The postoperative course was uneventful except for seromas. A chest computed tomographic scan performed 5 and 24 months after surgery showed no signs of recurrent aneurysm formation. A conservative surgical treatment including muscle flap transposition was effective in octogenarian.- - - - - - - - - - ranking = 7keywords = aneurysm (Clic here for more details about this article) |
10/29. Mycotic pseudoaneurysm of the ascending aorta after mediastinitis in an infant.Mycotic pseudoaneurysm of the aorta is a rare disease in children. We report our experience with a postoperative mycotic pseudoaneurysm of the ascending aorta secondary to mediastinitis after a modified fontan procedure. The pseudoaneurysm was successfully repaired using an autologous pericardial patch through a right thoracotomy under total circulatory arrest. During 6 months of postoperative follow-up, there were no recurrences of pseudoaneurysm formation.- - - - - - - - - - ranking = 159.64172618504keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
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