Treatment of the infected cardiac suture line.

After combined left ventricular aneurysmectomy and myocardial revascularization, four patients developed infection at the cardiac suture line. The infected cardiac suture line causes a variety of complications including cardiocutaneous fistula, erosion of pulmonary tissue, or pseudoaneurysm. The diagnosis is made by sinogram and left ventricular angiography, which is mandatory in all patients with suspected infection to guide the surgical approach. Once the diagnosis is made, aggressive and prompt surgical treatment is necessary to remove all infected material. A left anterolateral thoracotomy in the fifth or sixth intercostal space is the preferred approach. In the presence of a pseudoaneurysm, femoro-femoral bypass is required to reopen the left ventricle without cross-clamping the aorta. The septic material is removed, left ventricular wall and pericardial fibrous scar are closed, and extensive antibiotic treatment administered. All four patients survived and are free of complications two to three and a half years postoperatively.