[HSF] anaerobic late mediastinitis

Fri Mar 23 19:26:05 EDT 2007

Infections around prosthetic vascular grafts can often be controlled. If the infection involves the suture line, essentially an infection of the native aorta, it cannot often be controlled. Don't ask me why the native aorta is infected in some cases and not others. Although it is a popular notion that homograft material is more resistant to infection than prosthetic material, there is no evidence to support that perception. John Flege 

-----Original Message-----
From: damle at cableone.net
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 23 Mar 2007 3:42 PM
Subject: RE: [HSF] anaerobic late mediastinitis

I am too stunned to comment on "Yogurt in mediastinum".

To my unsophisticated mind it seems that infection (leading to eventual
death) will not be controlled unless the prosthetic graft is replaced with a
homograft, if it does.

Does anyone know if infection in a vascular graft in such a situation can be
controlled without replacing it?

Ajit Damle

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
Sent: Friday, March 23, 2007 11:04 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] anaerobic late mediastinitis

Keep chest open and I will tell something that will make your blood 
curdle but has worked well.
Apply fresh curds (Yoghurt) to the wound. This will displace the E coli 
and the colonized lactobacillus is nonpathogenic ansd will get 
eliminated. Later you can mobilize flaps/ close with drains.
IV antibiotics after mediastinal cultures etc etc are obvious.
Look for diverticulitis especially if a meat eater.
erdinç naseri wrote:
>
> Dear forum members,
> Opinion requested in the following case:
> 76 y/o male applied for CABG and ascending aortic aneurysm(6.5 cmm at 
> STJ ),No AI.Supracoronary  ascending aortic replacement with tubular 
> graft and CABG X 1 one month ago.Had abdominal distention at postop 
> 5.th day. No fever.Diagnosed as paralytic ileus. stoped oral intake 
> and followed by general surgery guys for one week conservatively.WBC 
> 4000 considered normal by them but I told them that this is relative 
> neutropenia in open heart surgery ( ususally 12-20000 in postop 
> period).After one week started oral feeding and discharged.Applied 2 
> days ago with anemia, weakness and abdominal distention.Hospitalized 
> by my colleagues and followed medicaly( Genaral surgeons agreed on 
> medical follow up),I saw the patient yesterday.No fever with Partial 
> dehiscence and wound was dirty( oozing bad smelly fluid).Immediately 
> taken to ICU and monitorized.Started inotropics for low cardiac out 
> put and took the patient to the operation room.Opened the sternum 
> .Very fetid odor and semiclear fluid.Grafts intact ,coronary graft 
> open.Deep bradycardia and hypotension and arrest followed by mannual 
> massage.Cardiac activity returned but with maximum inotropic 
> agents.Opened both pleura and put a tube in each and one in 
> suprasternal notch for irrigation.He is in ICU  with unremitting fever 
> (39-40)and Culture revealed E.coli.
> erdinc
>
>
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