[A report of successful treatment of mediastinitis and graft infection after ascending and aortic arch reconstruction].
A 43 years old male patient had composite graft replacement of ascending aorta and aortic arch with total reconstruction for his aortic valve regurgitation and ascending and aortic arch aneurysm. He developed high fever leucocytosis and in the early postoperative period and was diagnosed as aorta mediastinitis by proving bacterial culture positive in blood as well as in the drainage fluid. Re-exploration of mediastinal cavity was carried out and the necrotic tissues were removed as much as possible. The mediastinal cavity, especially around the graft was also thoroughly irrigated and washed with Iodine (Isozin) solution. Following this, mediastinal cavity was packed with non-diluted solution of Iodine sponge. Thereafter mediastinum was left open by applying sprint and patient was brought back to ICU. He was kept controlled ventilation and deep sedation. Mediastinal cavity was irrigated and re-packed with same solution every 8 hours for the following 48 hours so as to expect complete disinfection of the mediastinal cavity. He was brought back to the operation room again and midsternal incision was extended to the abdomen. Half portion of the major omentum was isolated from the stomach and transplanted into the mediastinal cavity with its vascular supply. Special care was taken to wrap around the graft with omentum. The sternum and skin were closed without any drainage tube. As postoperative complications most probably related to the application of high concentration of Iodine solution, he developed severe hepatic failure for which he was treated with hemofiltration. This was gradually improved and the infection was well controlled. He was discharged from the hospital on the 77th postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)
Harakawa
I
I
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Nakajima
N
N
Ando
M
M
Adachi
S
S
Takeuchi
S
S
Fujita
T
T
D000328:Adult; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001025:Aortitis / Q000188:drug therapy / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D006801:Humans; D007455:Iodine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000601:surgery*; D009852:Omentum / Q000637:transplantation; D011183:Postoperative Complications / Q000188:drug therapy / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D007507:Therapeutic Irrigation
D007455:Iodine