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J Thorac Cardiovasc Surg 2008;135:444-445
© 2008 The American Association for Thoracic Surgery

Brief Communication

Multiple thoracic aortic aneurysms after mediastinitis in an infant after repair of coarctation of the aorta

Laurie E. Profitlich, MD*, Constance G. Weismann, MD*,*, Shubika Srivastava, MD, Bruce D. Gelb, MD, Kahn Nguyen, MD, Umesh Joashi, MD

Department of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY

Received for publication September 7, 2007; accepted for publication September 20, 2007.

* Address for reprints: Constance Weismann, MD, One Gustave L. Levy Place, New York, NY, 10029. (Email: laurie.profitlich@mssm.edu; constance.weismann@mssm.edu).

The first 20% of the full text of this article appears below.

Clinical Summary

We describe the case of a 3.1-kg term infant with critical aortic coarctation transferred to our institution on the second day after birth. There was no risk factor for infection in the perinatal or birth history. An umbilical arterial catheter (UAC) and venous catheters were placed and a prostaglandin E1 infusion was initiated. Intermittent low-grade fever on days 4 and 5 after birth was attributed to the prostaglandin therapy.

On day 6, the patient was taken to the operating room for a resection and end-to-end anastomosis of a discrete coarctation through a left lateral thoracotomy. On entering the chest, we encountered purulent fluid in the mediastinum, and the aorta was adherent to the surrounding tissue, precluding mobilization. A subclavian flap repair was performed. The mediastinum was cultured and irrigated. The patient was transferred to the cardiac intensive care unit where vancomycin, cefepime, and gentamicin were started empirically. The UAC was removed. Osteomyelitis then developed. Blood and wound cultures persistently grew multi–drug resistant Staphylococcus aureus. The cultures finally became sterile on postoperative day 9 after modification of antibiotics (daptomycin, rifampin, and linezolid).

. . . [Full Text of this Article]






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