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Ann Thorac Surg 1990;50:982-983
© 1990 The Society of Thoracic Surgeons

Articles

Management of mycotic rupture of the ascending aorta after heart-lung transplantation

Johannes Albes, MDa,b,c, Axel Haverich, MD*,a,b,c, Joachim Freihorst, MDa,b,c, Horst von ver Hardt, MDa,b,c, Frauke Manthey-Stiers, MDa,b,c

a Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Federal Republic of Germany
b Department of Pediatric Pulmonology, Hannover Medical School, Hannover, Federal Republic of Germany
c Department of Medical Microbiology, Hannover Medical School, Hannover, Federal Republic of Germany

Accepted for publication May 25, 1990.

* Address reprint requests to Dr Haverich, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Konstanty-Gutschow-Strasse 8, D-3000 Hannover 61, Federal Republic of Germany.

A 19-year-old woman underwent heart-lung transplantation for obstructive bronchiolitis. Eleven days later mycotic rupture of the ascending aorta occurred. Emergency cardiopulmonary bypass was instituted via the femoral vessels and the chest was reopened under cardiac massage. Perforation of the aorta at the site of insertion of the cardioplegic cannula in the donor aorta was seen. Under circulatory arrest the infected area was excised, a pericardial patch plasty was performed, and the region was covered with a muscle flap. Postoperatively, Candida albicans was found in the excised specimen of the aorta, in drainage fluid, and in the bronchoalveolar lavage. High doses of antimycotics were administered intravenously and for irrigation of the mediastinum, which resulted in an eradication of fungi in all cultures 7 days later. Six weeks after reoperation the patient was discharged home, and she remains well 9 months postoperatively.




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