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Methicillin-resistant Staphylococcus aureus endocarditis following patch closure of a ventricular septal defect:
S Aoyagi1, T Kawara, T Mizoguchi
1Second Department of Surgery, Kurume University School Medicine, Japan.
Abstract:
We report herein the case of a 5-month-old infant who, after developing methicillin-resistant Staphylococcus aureus (MRSA) endocarditis following patch closure of a ventricular septal defect (VSD), was successfully treated by replacement of the Dacron patch with an autogenous pericardial patch. Initially, a large perimembranous VSD was repaired with a Dacron patch and after an uneventful recovery of 1 week, he began to spike intermittent fevers from 38 degrees C to 39 degrees C. Two blood cultures grew MRSA and a two-dimensional echocardiogram performed 16 days after surgery showed an irregular mass attached to the right ventricular aspect of the Dacron patch. At reoperation, a large vegetation attached to the Dacron patch was confirmed, but there was no patch dehiscence. Following removal of the patch, the VSD was repaired with an autogenous pericardial patch, soon after which the fever rapidly subsided. Imipenem, 125 mg every 6 h, and fosfomycin, 300 mg every 6 h, were administered for a total of 24 days after reoperation. The child remains well 12 months after his second operation.
Insights
A 5-month-old infant with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis after ventricular septal defect (VSD) repair was successfully treated. The Dacron patch was replaced with an autogenous pericardial patch, resolving the infection.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Surgical repair of VSDs, often with synthetic patches like Dacron, carries risks including infection.
- Methicillin-resistant Staphylococcus aureus (MRSA) endocarditis is a serious complication following cardiac surgery.
Observation:
- A 5-month-old infant developed MRSA endocarditis 1 week after VSD repair with a Dacron patch.
- Echocardiography revealed a vegetation on the Dacron patch, indicating infective endocarditis.
- The patient presented with persistent fevers and signs of systemic infection.
Findings:
- Surgical re-exploration confirmed a large vegetation on the Dacron patch.
- Successful treatment involved removal of the infected Dacron patch and VSD closure with an autogenous pericardial patch.
- Post-operative antibiotic therapy with imipenem and fosfomycin was administered for 24 days.
Implications:
- Autogenous pericardial patches may offer a safer alternative to synthetic materials in VSD repair, particularly in cases with high infection risk.
- Prompt recognition and surgical intervention are crucial for managing prosthetic valve endocarditis.
- This case highlights the successful management of a rare but severe complication of VSD repair, improving patient outcomes.