[Infection of an anastomosis: a formidable complication of operations for aortic coarctation].

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.