[Omentopexy associated with the use of Redon catheters in post-cardiac surgery mediastinitis with vascular prosthesis infection: immediate results in five patients]. / Omentopessi associata all'utilizzo dei cateteri di Redon nelle mediastiniti post-cardiochirurgiche con infezione di protesi vascolari: risultati immediati in cinque pazienti.

BACKGROUND: Post-cardiac surgery mediastinitis is a dangerous complication with an elevated mortality risk particularly when infection affects vascular prostheses. In this paper we report our experience with the use of extensive disinfection and washing of the mediastinum with iodopovidone, followed by omental transposition into the chest with the use of Redon catheters. METHODS: Between September 2001 and March 2007, 5 patients were treated with this technique (submitted to Bentall intervention in 2 cases, substitution of the ascending aorta, Bentall intervention with substitution of the aortic arch and substitution of the aortic arch in 1 case, respectively), due to a sternomediastinitis and correlated infection of the vascular prosthesis. Among them, 3 consisted of a redo surgery. RESULTS: One patient with unstable hemodynamic conditions died of multiorgan failure following a state of generalized sepsis; the remaining 4 patients had complete resolution of the clinical picture. None showed complications related to the procedure. The 4 survived patients were followed up at 1 month and underwent clinical and instrumental evaluation by chest computed tomography, which yielded negative results without signs of infection. CONCLUSIONS: Our limited experience definitely encourages us to use these combined techniques in the treatment of post-cardiac surgery mediastinitis in patients with vascular prostheses.

[Bentall operation after previous repair of tetralogy of Fallot]. / Intervento di Bentall in paziente con pregresso intervento di correzione di tetralogia di Fallot.

Pathologies that involve the ascending aorta are described in case reports of patients after complete repair of tetralogy of Fallot. Here, we present a case report. Preoperative tests showed an aortic ratio of > 1.5. The patient was operated on replacement of the ascending aorta according to the Bentall technique. At present, the guidelines for replacement of the ascending aorta recommend an aortic ratio of > 1.5 and in case of Marfan syndrome of > 1.3. In these patient subsets, cystic medial necrosis and an increased risk of aortic dissection have been described. Therefore, as for Marfan syndrome, why an aortic ratio of >1.3 should not be considered a proper surgical indication also for these patients?