Wellens F, Vanermen H
Department of Cardiovascular Surgery, Aalst, Belgium.
J Card Surg. 1988 Jun;3(2):109-18. doi: 10.1111/j.1540-8191.1988.tb00231.x.
After combined left ventricular aneurysmectomy and myocardial revascularization, four patients developed infection at the cardiac suture line. The infected cardiac suture line causes a variety of complications including cardiocutaneous fistula, erosion of pulmonary tissue, or pseudoaneurysm. The diagnosis is made by sinogram and left ventricular angiography, which is mandatory in all patients with suspected infection to guide the surgical approach. Once the diagnosis is made, aggressive and prompt surgical treatment is necessary to remove all infected material. A left anterolateral thoracotomy in the fifth or sixth intercostal space is the preferred approach. In the presence of a pseudoaneurysm, femoro-femoral bypass is required to reopen the left ventricle without cross-clamping the aorta. The septic material is removed, left ventricular wall and pericardial fibrous scar are closed, and extensive antibiotic treatment administered. All four patients survived and are free of complications two to three and a half years postoperatively.
在进行左心室动脉瘤切除术和心肌血运重建联合手术后，有4例患者在心脏缝合线处发生感染。感染的心脏缝合线会引发多种并发症，包括心皮瘘、肺组织侵蚀或假性动脉瘤。诊断通过窦道造影和左心室血管造影进行，对于所有疑似感染的患者，这两项检查是必不可少的，以指导手术方法。一旦确诊，必须积极迅速地进行手术治疗，以清除所有感染物质。首选的手术入路是在第五或第六肋间进行左前外侧开胸术。如果存在假性动脉瘤，则需要进行股-股旁路手术，以便在不夹闭主动脉的情况下重新打开左心室。清除感染物质，关闭左心室壁和心包纤维瘢痕，并给予广泛的抗生素治疗。所有4例患者均存活，术后两至三年半无并发症。
