Abstract
The patient was a 43-year-old female who had received repeated open surgery for adhesive bowel obstruction due to underlying Crohn's disease. Seven years earlier, as enteral feeding became unfeasible, long-term indwelling catheter was installed through the right subclavian vein to perform total parenteral nutrition (TPN). One month before the presentation, she showed spiking fever, and methicillin-resistant Staphylococcus aureus was isolated from the blood. Echocardiography and magnetic resonance images revealed that thrombi filled the right subclavian, internal jugular, and innominate veins through the superior vena cava (SVC), and formed a tumor of 20 mm in diameter within the right atrium. As vancomycin was not effective to control the infection, we performed surgical treatment for the thrombi complicated by catheter-associated bloodstream infection. We started the heart surgery via a median sternotomy approach under general anesthesia. When the right atrium was incised obliquely, we found that organized thrombi tightly adhered to the wall of the right atrium and SVC. We carefully removed the thrombi as much as possible and finally withdrew the catheter. We next reconstructed the SVC and right atrium by using autologous pericardial patch and Prolene running suture. She had an uneventful postoperative course and infective symptoms quickly resolved. The patient is currently receiving TPN by using the replaced central venous catheter through the right subclavian vein. Six months after the surgery, reconstructed SVC is patent. Nevertheless, the long-term patency of SVC reconstructed using autologous pericardial patch remains to be determined.
