Inoue T, Sato S, Kato H, Sakagoshi N, Inoue M, Takenaka H
Department of Cardiovascular Surgery, Kinan General Hospital, Wakayama, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Aug;43(8):1166-70.
The formation of pseudoaneurysm is an uncommon complication of after coronary artery bypass grafting (CABG). We report a 66-year-old man in whom an anastomotic pseudoaneurysm of the ascending aorta derived from mediastinitis after repeat CABG. At operation, the pseudoaneurysm was revealed to be involved in the proximal anastomotic site of a saphenous vein graft to the RCA. The aneurysm was resected and the defect was repaired with woven dacron patch under deep hypothermic circulatory arrest. In addition, omental transposition was performed to treat mediastinitis radically. Debris of the pseudoaneurysm grew methicillin-resistant Staphylococcus aureus (MRSA), so vancomycin was administered intravenously for 8 weeks. The postoperative course was uneventful. We considered that omental transfer can be very effective in the management of severe mediastinitis, especially that due to an infected pseudoaneurysm or widespread mediastinitis caused by MRSA.
假性动脉瘤的形成是冠状动脉旁路移植术（CABG）后一种罕见的并发症。我们报告了一名66岁男性，其在再次冠状动脉旁路移植术后因纵隔炎形成升主动脉吻合口假性动脉瘤。手术中发现假性动脉瘤累及大隐静脉移植至右冠状动脉（RCA）的近端吻合部位。切除动脉瘤后，在深低温循环停搏下用编织涤纶补片修复缺损。此外，进行了网膜移位术以彻底治疗纵隔炎。假性动脉瘤碎片培养出耐甲氧西林金黄色葡萄球菌（MRSA），因此静脉给予万古霉素8周。术后过程顺利。我们认为网膜转移术在严重纵隔炎的治疗中可能非常有效，尤其是对于由感染性假性动脉瘤或MRSA引起的广泛纵隔炎。
