Reconstruction of the right atrium using an extracellular matrix patch in a patient with severe mediastinal aspergillosis

Abstract

Introduction: We report a case of reconstruction of the right atrial wall using a novel bioresorbable patch derived from porcine small intestinal submucosa.

Presentation of case: Our patient presented with mediastinal aspergillosis as a result of chronic steroid therapy for an oligodendroglioma. Hemodynamic compromise and syncopal episodes secondary to the mass effect of the aspergilloma prolapsing through tricuspid valve necessitated palliative surgical excision.

Discussion: Intraoperatively, it was confirmed that the lesion had eroded into the right atrium and partially occluded right ventricular inflow. In order to achieve appropriate palliation a wide resection of the atrial wall was necessary. The atrial reconstruction was then performed using an extracellular matrix-derived biopatch. This case was further complicated by postoperative bleeding requiring re-operation.

Conclusion: We describe the methods used for repair using a novel patch in this rare case of invasive aspergillosis extending into the right atrium and resulting in compromise of diastolic right ventricular filling.

Fig. 1

Computed tomography of the chest with intravenous contrast (coronal, transverse and sagittal reconstructions). Images demonstrate the aspergilloma mass occupying the anterior mediastinum and penetrating into the right atrium (red arrows).

Fig. 2

The aspergillus mass (A) is being removed and the defect in right atrium (B) is exposed. Infectious white material surrounds the atrial wall defect obscuring anatomical details (C). Complete repair of right atrial defect with the ECM implant (dashed line) sewn into place with a continuous suture line (lower panel).