Mediastinitis and mycotic aneurysm of the aorta after orthotopic heart transplantation.
After cardiac transplantation, bacterial mediastinitis is a rare but dangerous early complication. Of the 113 patients who underwent heart or heart-lung transplantation at our hospital from August 1981 to April 1989, 8 developed purulent mediastinitis. Treatment involved surgical débridment, local irrigation, drainage, and high-dose systemic antibiotics. No patient died of an acute mediastinal infection. In 2 cases, however, chronic mediastinitis led to the formation of a huge mycotic aneurysm of the ascending aorta. Eleven days after surgical intervention for rupture, 1 patient died of aneurysmal rerupture; the 2nd patient remains well 16 months after prosthetic replacement of the ascending aorta and reconstruction of the necrotic proximal portion of the left coronary artery with a saphenous vein patch.
Anthuber
M
M
Department of Cardiac Surgery, University Hospital Munich Grosshadern, Munich, Federal Republic of Germany.
Kemkes
B M
BM
Kreuzer
E
E
Gokel
M
M
Schuetz
A
A
Kugler
C
C
Sudhoff
F
F