Candida mediastinitis with aortic rupture after congenital heart surgery.

We describe the fatal course of a Candida albicans mediastinitis in a 4-year-old child after truncus arteriosus repair, leading to aortic rupture. The diagnosis was made by computer tomography and confirmed at exploratory sternotomy, with positive swab and blood cultures. After local surgical lavage, Amphotericin B therapy was started, but the child died due to aortic rupture 2 weeks later, despite negative blood cultures. The potential risk of aortic rupture with Candida mediastinitis after congenital heart repair exists, and combined aggressive surgical and medical treatment is essential. Guidelines for the diagnosis and therapy in pediatric patients with post-operative mycotic mediastinitis are required.

Cardiovascular MR imaging in neonates and infants with congenital heart disease.

Cardiovascular magnetic resonance (MR) imaging has become an important alternative to echocardiography and angiocardiography in the evaluation of patients with congenital heart disease (CHD). It is increasingly being used in neonates and infants for the initial investigation of CHD or as follow-up after surgery or catheter-guided intervention. Specific indications for cardiovascular MR imaging in neonates and infants include investigation of the thoracic vasculature, quantification of the ventricular volumes, and evaluation of primary cardiac tumors. To obtain good-quality MR images in neonates and infants, it is essential to adjust the technical parameters of the pulse sequences to the small size and fast heart rates of the patients. Various MR imaging techniques are available that are effective in demonstrating the complex morphologic features of the cardiovascular system and that provide additional functional and hemodynamic information. The information provided by cardiovascular MR imaging is useful for treatment planning and, in many cases, may obviate potentially harmful cardiac catheterization.