Management and prevention of cardiovascular hemorrhage associated with mediastinitis

Annals of Surgery
G GeorgiadeE Ritter

Abstract

To elucidate the causes of cardiovascular hemorrhage associated with mediastinitis and to review recommendations for prevention and treatment. Mediastinal debridement with immediate or early coverage using healthy, vascularized tissue has lead to greatly reduced morbidity and mortality for patients with mediastinitis. Myocardial hemorrhage has been anecdotally reported. Over a 36-month period, 7 patients developed massive cardiovascular bleeding after undergoing debridement for poststernotomy mediastinitis. Causes included puncture or erosion by a sternal edge in three and tearing at the myocardial-sternal interface in four. Five patients survived and remain infection-free at an average of 24 months of follow-up. In these patients, ventricular defects were closed with pledgeted sutures and muscle transposition was used concomitantly to reinforce the repair. This involved a slide of the left pectoralis major muscle and turnover of the right pectoralis in three patients, bilateral sliding in one patient, and bilateral pectoralis and an omental flap in one patient who required additional coverage of the lower mediastinum. When a patient who has undergone mediastinal debridement shows evidence of significant bleeding, we recommend ...Continue Reading

References

Nov 1, 1978·World Journal of Surgery·F D LoopD M Cosgrove
Sep 1, 1989·Plastic and Reconstructive Surgery·F NahaiM J Jurkiewicz
Jul 1, 1982·Plastic and Reconstructive Surgery·N Chang, S J Mathes

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Citations

Mar 27, 2003·The Journal of Thoracic and Cardiovascular Surgery·Alon YellinDavid Simansky
Apr 28, 2004·Journal of Cardiac Surgery·Ali KhoynezhadL Michael Graver

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