Mediastinitis after cardiac transplantation
| Autor: | Luiz F. Camargo, André Gustavo Bombana Nicoletti, Fernando Bacal, Noedir Antônio Groppo Stolf, Daniela Meira, Alfredo Inácio Fiorelli, Andréa Freitas, Edimar Alcides Bocchi |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_treatment Autopsy cardiac transplantation Staphylococcal infections Postoperative Complications Medicine Humans Aged Retrospective Studies Heart transplantation immunosuppression business.industry Pleural empyema Incidence Mediastinum Surgical wound Middle Aged Staphylococcal Infections medicine.disease Mediastinitis Surgery Transplantation medicine.anatomical_structure lcsh:RC666-701 Heart Transplantation Female Cardiology and Cardiovascular Medicine business mediastinitis |
| Zdroj: | Arquivos Brasileiros de Cardiologia, Vol 74, Iss 5, Pp 425-430 (2000) Arquivos Brasileiros de Cardiologia v.74 n.5 2000 Arquivos Brasileiros de Cardiologia Sociedade Brasileira de Cardiologia (SBC) instacron:SBC Arquivos Brasileiros de Cardiologia, Volume: 74, Issue: 5, Pages: 425-430, Published: MAY 2000 |
| ISSN: | 0066-782X |
| Popis: | OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6%) of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years) and 10 (83.3%) patients were males. Seven (58.3%) patients showed sternal stability on palpation, 4 (33.3%) patients had pleural empyema, and 2 (16.7%) patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7%) patients. Staphylococcus epidermidis was identified in 2 (16.7%) patients, Enterococcus faecalis in 1 (8.3%) patient, and the cause of mediastinitis could not be determined in 1 (8.3%) patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7%) patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3%) patient. Out of this series, 5 (41.7%) patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3%) patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis. |
| Databáze: | OpenAIRE |
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