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Punch Hole Aneurysm Of Ascending Aorta Secondary To Sternal Wound Infection
Anas Ahmad.
Omar Hospital and Cardiac Centre, LAHORE, Pakistan.
Background:Punch hole aneurysm of the ascending aorta is a rare complication after CABG usually resulting from a sternal wound infection. This case report highlights the presentation, diagnosis and management of this uncommon condition.
Methods:A 45-year-old male post-CABG for triple vessel disease, initially recovered well but presented two months later with fever, chest pain and sternal wound discharge treated as a superficial infection. One month later, he returned with similar symptoms and imaging revealed a large saccular aneurysm (81×65×61 mm) from the proximal aortic arch and a smaller RCA aneurysm. Emergency surgery was performed with cardiopulmonary bypass, sternotomy and deep hypothermic circulatory arrest (DHCA) to repair the 4×3 cm aortic defect using a Dacron patch and bioglue. Postoperatively,
Pseudomonas aeruginosa infection was treated with antibiotics and the patient improved gradually with rehabilitation. At 3 months, he showed no recurrence of the aneurysm and regained mobility with walker support.
Discussion Punch hole aneurysm of the ascending aorta following sternal wound infection post-CABG is rare and results from local infection and wall weakening. Early diagnosis via CT imaging and emergent surgical repair with debridement and antibiotics are crucial to prevent rupture and life-threatening complications.
Conclusion: Punch hole aneurysm of the ascending aorta after CABG due to sternal wound infection is rare but requires early diagnosis and urgent treatment. Timely surgical intervention and antibiotic therapy are critical for a successful outcome.
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