[Vascular prosthesis infection in thoracic aorta surgery: review of the experience and a case report illustrating treatment with an unconventional technique].
We report the case of a 37-year-old-female patient who had undergone a Bentall procedure at our service and returned with intense chest pain and acute aortic dissection type III, which was diagnosed and clinically treated. One year after this episode, this dissection expanded, and the patient underwent surgery with interposition of a Dacron graft in the descending aorta. In the immediate postoperative period, the patient experienced left bronchopneumonia and was discharged afebrile and in good condition. One month after discharge, she returned with fever and toxemia. Pleural empyema was diagnosed, and she underwent an exploratory thoracotomy that did not confirm this diagnosis, but revealed intense effusion thickening. Four months after the exploratory thoracotomy, Klebsiella pneumoniae and Enterobacter sp were isolated in a blood culture. Magnetic resonance imaging revealed shapes compatible with perigraft infection. With this clinical and laboratory picture, graft removal was indicated as was axillo-bifemoral grafting. Surgery was successfully performed, the patient was discharged in good condition, and remains well after a 57-month follow-up without complications. The methods used for diagnosis and treatment of prosthesis infection in thoracic aorta surgery are discussed.
Fontes
Ronaldo Ducceschi
RD
Instituto do Coração, Hospital das Clínicas, FM, USP.
Stolf
Noedir Antônio Groppo
NA
Marino
Júlio Cesar
JC
Pamplona
David
D
Avila
Luis Francisco
LF
Oliveira
Sérgio Almeida
SA
D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D006801:Humans; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012086:Reoperation