Successful Surgical Repair for Rupture of Penetrating Atherosclerotic Ulcer with MRSA Infection of a Porcelain Descending Aorta

iDivision of Cardiothoracic Surgery, Asahikawa City Hospital, Asahikawa, Japanj

Kimihiro Yoshimoto Junichi Oba Taro Minamida
Akira Adachi Tsukasa Miyatake , Hidetoshi Aoki
A 41-year-old man with focal glomerulosclerosis had been treated by hemodialysis for 22 years. Kidney transplantation from a living donor was performed once, but the transplanted kidney was removed out because it had been infected by methicillin-resistant Staphylococcus aureus about 3 months previously. He was admitted to our hospital with over 38 fever 2 months after the removal. He had hemoptysis and marked back pain. Computed tomography scan revealed ruptured descending aorta. The descending aorta was circumferentially calcified but not enlarged. We thought that a penetrating atherosclerotic ulcer had formed in a crack of the porcelain aorta and ruptured with infection. First we tried endovascular treatment with stent-graft implantation. It was useful to control hemoptysis, but a small amount of type I leakage remained. Finally, after controlling the infection, we performed prosthesis replacement with extra-corporeal circulation and surrounded the artificial aorta with the omentum. The postoperative course was uneventful and he recovered completely.
  Jpn. J. Cardiovasc. Surg. 38:44-48i2009j