[Rupture of an infected vein graft in the course of mediastinitis following coronary artery bypass grafting: report of a case].
A 51-year-old man developed a Staphylococcal mediastinitis and septicemia 23 days after coronary artery bypass grafting. He was initially treated with surgical debridement and closed irrigation with 0.5% povidone iodine solution. However, since the infection could not be eradicated by this method, an open packing method was subsequently required. Nineteen days after the diagnosis of mediastinitis, massive bleeding occurred due to rupture of an infected vein graft to the LAD. Although he went into profound hemorrhagic shock, suture ligation of the vein graft was successfully performed. The sternum was reapproximated 34 days after the initial debridement. Postoperative coronary angiograms revealed the patent vein grafts to the RCA and LCX, and PTCA was performed to the native stenosis of the LAD. The patient was discharged 5 months after the bypass operation and is now doing well 3 years postoperatively. Rupture of the heart or vessels in the course of postoperative mediastinitis is a very rare but highly lethal complication. We think that it is important to eradicate the infection as soon as possible to prevent the bleeding complication and that the decision as to which method, closed or open, should be employed, is crucial.
Kohno
H
H
Department of Cardiovascular Surgery, Matsuyama Red Cross Hospital.
Hisahara
M
M
Umesue
M
M
Matsui
K
K
Ando
H
H
Sakamoto
M
M
D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications*; D008875:Middle Aged; D011183:Postoperative Complications; D012422:Rupture, Spontaneous; D013203:Staphylococcal Infections / Q000150:complications*; D014680:Veins / Q000637:transplantation