Kachaner J, Fermont L, Magny J F, Villain E, Sidi D, Pedroni E, Piéchaud J F
Arch Mal Coeur Vaiss. 1983 May;76(5):601-6.
One 12 day newborn, a 2 year old infant and two children aged 10 and 14, operated for isthmic coarctation of the aorta by three different surgical techniques (resection-anastomosis, angioplasty with an autograft, prosthetic graft) suffered infection of the operative field, resulting in septicemia (3 staphylococcal and 1 yeast infections). The aorta ruptured after 4 days, before any collection of pus in the newborn but a mycotic false aneurysm developed in the three other patients: this was the cause of death by aortic rupture during the 5th postoperative week in one case but was diagnosed and operated successfully in the other two, 13 and 54 days after their first operation. These complications are well known. Therefore, these patients should be closely followed up for at least one month. The occurrence of pyrexia, even slight or late, should be treated with suspicion. Characteristic dilatation of the part of the aorta operated on should be actively looked for by simple radiography, 2D echocardiography and, when in doubt, right heart angiocardiography. The diagnosis is a surgical emergency: the safest technique consists in initially establishing an aorto-aortic deviation by a right sided approach followed by exclusion of the lesion. Surgery is the only means of preventing catastrophic rupture of the aorta.
一名12天大的新生儿、一名2岁婴儿以及两名分别为10岁和14岁的儿童，因主动脉峡部缩窄接受了三种不同的外科手术（切除吻合术、自体移植物血管成形术、人工血管移植术），术后均出现手术部位感染，导致败血症（3例葡萄球菌感染和1例酵母菌感染）。新生儿在术后4天主动脉破裂，此时尚无脓液形成，但其他三名患者均形成了真菌性假性动脉瘤：其中一例在术后第5周因主动脉破裂死亡，另外两例分别在首次手术后13天和54天被诊断出真菌性假性动脉瘤并成功接受手术。这些并发症是众所周知的。因此，应对这些患者进行至少一个月的密切随访。即使是轻微或延迟出现的发热，也应予以怀疑并进行治疗。应通过简单的X线摄影、二维超声心动图，必要时通过右心心血管造影，积极寻找手术部位主动脉的特征性扩张。该诊断属于外科急症：最安全的技术是首先通过右侧入路建立主动脉-主动脉转流，然后切除病变。手术是预防主动脉灾难性破裂的唯一方法。
