Matsuzaki K, Shiiya N, Kunihara T, Miyatake T, Hatta E, Murashita T, Yasuda K
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Kyobu Geka. 2003 Mar;56(3):207-10.
A 70-year-old man developed meticillin-resistant staphylococcus aureus (MRSA) mediastinitis after prosthetic graft replacement of the ascending aorta. The sternal wound was reexplored and a single-stage procedure of irrigation, debridement, and omental transposition was performed. Ten months after the first operation, he suffered recurrence of pyrexia and the presence of false aneurysm originated from the distal suture line was diagnosed by the chest computed tomography (CT) scan. Re-replacement of the ascending aorta and proximal hemiarch with rifampicin soaked Gelseal was successfully performed. Hypothermic perfusion with circulatory arrest through peripheral cannulation and left ventricular venting via a left anterior thoracotomy was useful to obtain safe reentry in the operation of retrosternal false aneurysm.
一名70岁男性在升主动脉人工血管置换术后发生耐甲氧西林金黄色葡萄球菌(MRSA)纵隔炎。对胸骨伤口进行再次探查,并实施了冲洗、清创和网膜移位的一期手术。首次手术后10个月,他出现发热复发,胸部计算机断层扫描(CT)诊断出源自远端缝线处的假性动脉瘤。成功地使用利福平浸泡的Gelseal再次置换升主动脉和近端半弓。通过外周插管进行低温灌注停循环,并经左前开胸进行左心室引流,这有助于在胸骨后假性动脉瘤手术中安全再次进入手术区域。