High-pressure irrigation and gentian-violet application for mediastinitis following replacement of ascending aorta and aortic valve

Abstract

Mediastinitis following ascending aortic replacement is intractable and potentially fatal, and the feature is characterized as having both high mortality and morbidity when its causation pathology is methicillin-resistant Staphylococcus aureus (MRSA). Possible treatments for the condition, which include debridement, irrigation, and healthy tissue transposition, often result in failure. We report a case of MRSA mediastinitis after replacement of the ascending aorta and the aortic valve successfully treated by continuous saline lavage and drainage, debridement, high-pressure irrigation, and gentian-violet application, and delayed omental-flap transposition. The application of gentian violet and high-pressure irrigation may provide an additional option to the standard therapy for intractable mediastinitis after ascending aortic replacement.

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

“…Gentian violet seems to have replaced PI as an antiseptic in mediastinal irrigation due to its low toxicity and excellent anti-staphylococcal activity (including methicillin-resistant S. aureus ) and against Gram-negative bacteria. The only published experiences on this are isolated case communications [ 285 , 286 , 287 ].…”

Gentian Violet: a 19th century drug re‐emerges in the 21st century

“…Outside the field of dermatology, GV has been successful to treat MRSA in otitis media , mediastinitis , prosthetic vascular bypass graft infection , as well as nasal carriage of MRSA . In the face of increasing incidence and emerging resistance to standard therapies, GV has emerged as a potential treatment option for MRSA infections.…”

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report

“…For the extrapleosteal space that could not be filled, we utilized air filling to promote lung re-expansion. Vancomycin was administered perioperatively, and the pyothorax cavity was irrigated with gentian-violet solution, which has been reported to have antimicrobial effects against MRSA [ 4 ]. However, it is important to note that Methylrosaniline chloride (also known as Gentian Violet, Crystal Violet, and marketed as Pyoctanin) faced regulatory changes.…”