title: Surgical strategy for impending rupture of an infected anastomotic pseudoaneurysm of the aorta 9 years after a Bentall procedure: radical surgery involving en bloc resection of the infected sternum, pseudoaneurysm, and artificial vascular graft.
abstract: Infection of the sternum and anterior mediastinitis after open heart surgery are serious complications that are intractable with high case fatality rates. Frequently, infection spreads to an artificial foreign body in the mediastinum, causing difficulties with treatment. We report a case of infected pseudoaneurysm of the aorta at the anastomotic site of the artificial vascular graft. The infection spread from sternal osteomyelitis 9 years 5 months after aortic root replacement (Bentall procedure) for acute aortic dissection. We performed radical surgery that included en bloc resection of the infected sternum, pseudoaneurysm, and artificial vascular graft, with successful results. We report here the surgical strategy including the approach.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Fukuoka, Japan. katayay@cc.saga-u.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Katayama
authors.forename: Naoki
authors.initials: N
authors.lastname: Minato
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sakaguchi
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D017541:Aneurysm, False / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D000785:Aneurysm, Infected / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020878:Device Removal; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D009852:Omentum / Q000637:transplantation; D010019:Osteomyelitis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010369:Pectoralis Muscles / Q000637:transplantation; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D013249:Sternum / Q000382:microbiology / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome