[Methicillin-resistant Staphylococcus aureus endocarditis following patch closure of ventricular septal defect]

Mediastinitis due to methicillin-resistant Staphylococcus aureus was found on the ninth postoperative day after patch closure of ventricular septal defect (VSD) in a six-month-old girl. Intravenous administration of vancomycin and debridement of the wound followed by irrigation with povidone iodine and vancomycin led to wound disinfection, but blood cultures continued positive. On the 22nd postoperative day, an echocardiographic examination revealed vegetations in the right ventricle. An emergency open heart operation was undergone. The largest vegetation was 1 x 2 cm in size, originating from the intracardiac patch used for closure of the VSD. The pulmonary and tricuspid valves were also involved. After removal of the infected tissues, including the two cusps of the pulmonary valve and a part of the tricuspid valve, the ventricular septal defect was closed again with a woven Dacron patch. The defect in the tricuspid valve was repaired. Postoperative examinations revealed severe pulmonary regurgitation and mild tricuspid regurgitation, but the cardiac function was good and neither vegetation nor leakage around the patch was recognized.