Bojar R M, Payne D D, Sheffield A B, Rastegar H, Stetz J J, Cleveland R J
Department of Cardiothoracic Surgery, New England Medical Center, Boston, MA 02111.
Ann Thorac Surg. 1988 Aug;46(2):182-6. doi: 10.1016/s0003-4975(10)65893-6.
Mediastinal wound infections following open-heart operations are successfully managed in most patients by aggressive debridement and placement of substernal drainage catheters or application of omental or muscle flaps. Nonetheless, the involvement of foreign bodies, such as felt pledgets adjacent to cardiac structures, can result in infections that persist despite flap coverage and can present as mycotic false aneurysms of the ascending aorta. We present the cases of 3 patients who underwent successful repair of such aneurysms late after surgical treatment of mediastinal wound infections. We describe our technique of repair using groin cannulation for bypass, moderate hypothermia, and circulatory arrest to improve exposure and minimize bleeding.
大多数接受心脏直视手术的患者，通过积极清创、放置胸骨后引流管或应用网膜或肌瓣，纵隔伤口感染可得到成功处理。然而，异物的存在，如靠近心脏结构的毡片，可导致感染，尽管有皮瓣覆盖仍会持续存在，并可表现为升主动脉霉菌性假性动脉瘤。我们报告了3例患者的病例，他们在纵隔伤口感染手术治疗后期成功修复了此类动脉瘤。我们描述了我们的修复技术，即使用腹股沟插管进行旁路、中度低温和循环停止，以改善暴露并减少出血。
