Surgical Management of Necrotizing Mediastinitis With Large Aortic Pseudoaneurysm.
We report a patient with necrotizing mediastinitis complicated by a giant retrosternal mycotic pseudoaneurysm and prosthetic valve endocarditis successfully managed with a redo sternotomy under hypothermic circulatory arrest. The approach then included extensive débridement of the mediastinum, replacement of the ascending aorta and aortic arch with selective antegrade cerebral perfusion, redo aortic valve replacement, and wound closure with omental flap and myocutaneous flap. After a 2-year survival, the patient suffered reinfection from hemodialysis. Our approach is also applicable to more common presentations of mediastinitis.
University of Michigan Medical School, University of Michigan Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan.
Andrew T
AT
Chevalier
Department of Radiology, University of Michigan Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan.
Minhaj S
MS
Khaja
Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: boya@med.umich.edu.
Bo
B
Yang
D017541:Aneurysm, False / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D003646:Debridement; D004696:Endocarditis / Q000209:etiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis; D013524:Surgical Flaps