Successful treatment of left ventricular patch infection by latissimus dorsi muscle flap covering without patch removal


Removal of the infected prosthesis is considered an essential procedure in the treatment of prosthetic graft infection following cardiovascular surgery. Here, we present a case of left ventricular patch infection following repair of left ventricular rupture that was successfully treated by coverage with a latissimus dorsi muscle flap without patch removal. A 61-year-old man underwent double-patch repair for left ventricular-free wall rupture following posterior myocardial infarction. He underwent drainage and omental transposition with re-sternotomy for postoperative mediastinitis by Candida albicans, followed by pericardial fenestration via left thoracotomy for infectious pericarditis; however, left ventricular patch infection was detected. Considering the high invasiveness of a reoperation for patch removal, we preserved and covered the patch using a left pedicled latissimus dorsi muscle flap via left thoracotomy. The postoperative course was uneventful, and the patient was asymptomatic with no signs of recurrence at 30 months.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Coselli JS, Koksoy C, LeMaire SA. Management of thoracic aortic graft infections. Ann Thorac Surg. 1999;67:1990–3.

    CAS  Article  Google Scholar 

  2. 2.

    Hargrove WC III, Edmunds LH Jr. Management of infected thoracic aortic prosthetic grafts. Ann Thorac Surg. 1984;37:72–7.

    Article  Google Scholar 

  3. 3.

    Calligaro KD, Veith FJ, Schwartz ML, Savarese RP, DeLaurentis DA. Are gram-negative bacteria a contraindication to selective preservation of infected prosthetic arterial grafts? J Vasc Surg. 1992;16:337–46.

    CAS  Article  Google Scholar 

  4. 4.

    Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–9.

    CAS  Article  Google Scholar 

  5. 5.

    Akowuah E, Narayan P, Angelini G, Bryan AJ. Management of prosthetic graft infection after surgery of the thoracic aorta: removal of the prosthetic graft is not necessary. J Thorac Cardiovasc Surg. 2007;134:1051–2.

    Article  Google Scholar 

  6. 6.

    LeMaire SA, Coselli JS. Options for managing infected ascending aortic grafts. J Thorac Cardiovasc Surg. 2007;4:839–43.

    Article  Google Scholar 

  7. 7.

    Fansa H, Handstein S, Schneider W. Treatment of infected median sternotomy wounds with a myocutaneous latissimus dorsi muscle flap. Scand Cardiovasc J. 1998;32:33–9.

    CAS  Article  Google Scholar 

  8. 8.

    Dejesus RA, Paletta JD, Dabb RW. Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap. J Cardiovasc Surg. 2001;42:359–64.

    CAS  Google Scholar 

  9. 9.

    Taguchi S, Mori A, Suzuki R, Ishida O. Technique for using pedicled latissimus dorsi muscle flaps to wrap prosthetic grafts in an infected thoracic aorta. Ann Vasc Surg. 2013;27:1223–7.

    Article  Google Scholar 

  10. 10.

    Tizian C, Borst HG, Berger A. Treatment of total sternal necrosis using the latissimus dorsi muscle flap. Plast Reconstr Surg. 1985;76:703–7.

    CAS  Article  Google Scholar 

  11. 11.

    Izaddoost S, Withers EH. Sternal reconstruction with omental and pectoralis flaps: a review of 415 consecutive cases. Ann Plast Surg. 2012;69:296–300.

    CAS  Article  Google Scholar 

  12. 12.

    Owen K, Wilshaw SP, Homer-Vanniasinkam S, Bojar RA, Berry H, Ingham E. Assessment of the antimicrobial activity of acellular vascular grafts. Eur J Vasc Endovasc Surg. 2012;43:573–81.

    CAS  Article  Google Scholar 

  13. 13.

    Leontyev S, Borger MA, Modi P, Lehmann S, Seeburger J, Doenst T, Mohr FW. Surgical management of aortic root abscess: a 13-year experience in 172 patients with 100% follow-up. J Thorac Cardiovasc Surg. 2012;143:332–7.

    Article  Google Scholar 

  14. 14.

    Hostalrich A, Ozdemir BA, Sfeir J, Solovei L, Alric P, Canaud L. Systematic review of native and graft-related aortic infection outcome managed with orthotopic xenopericardial grafts. J Vasc Surg. 2019;69:614–8.

    Article  Google Scholar 

Download references


The authors would like to thank Enago ( for the English language review.

Author information



Corresponding author

Correspondence to Kousuke Mori.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mori, K., Furukawa, K., Ishii, H. et al. Successful treatment of left ventricular patch infection by latissimus dorsi muscle flap covering without patch removal. Gen Thorac Cardiovasc Surg (2020).

Download citation


  • Ventricular patch infection
  • Latissimus dorsi muscle flap
  • Xenopericardium