title: Successful treatment of mediastinitis in a young child by omental translocation following extracardiac Fontan graft placement.
abstract: Mediastinitis after a midline sternotomy can become a serious complication, especially after implantation of prosthetic vascular grafts. We present a case of a three-year-old boy with hypoplastic left heart syndrome who developed mediastinitis following his third-stage palliation (Fontan operation). Rather than following the "traditional" surgical therapy of graft explantation, debridement, and replacement, we chose to preserve the graft and protect it by omental translocation. The relative merits of this therapeutic approach, which is rarely utilized and underappreciated in children, are outlined and discussed.
authors.affiliation: Cardiac Surgery, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, NY, USA pierrelucbernier@me.com.
authors.forename: Pierre-Luc
authors.initials: PL
authors.lastname: Bernier
authors.affiliation: Cardiac Surgery, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, NY, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Gottlieb
authors.affiliation: Cardiac Surgery, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, NY, USA.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001442:Bacteroides Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D001441:Bacteroides fragilis / Q000302:isolation & purification; D002675:Child, Preschool; D003646:Debridement; D018729:Fontan Procedure / Q000009:adverse effects; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D009852:Omentum / Q000637:transplantation*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D056346:Sternotomy / Q000009:adverse effects*; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents
keywords: congenital heart disease; fontan; mediastinal infection; morbidity