Tanaka M, Shimizu Y, Iwaoka S, Watanabe H, Nakamura N
Department of Cardiovascular Surgery, Kansai Hospital, Amagasaki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Mar;42(3):465-71.
A corrective operation of TOF was performed in a 32-year-old male with RV outflow patch. He had a purulent discharge due to MRSA 6 days after operation. Omental transposition with a single wound closure was performed to treat the mediastinitis. After re-operation, he had a high grade fever, flail sternum, and purulent discharge. Re-re-operation was performed due to recurrence of mediastinitis, however intraoperative findings revealed isolated heart included RV outflow patch, from infection. Therefore, a major pectoral muscle flap was created to treat the sternal wound infection. He was discharged 3 months after the second operation, having an uneventful course. However he was later admitted to our hospital again with high grade fever. Blood culture showed MRSA. We suspected the recurrence of mediastinitis, since Ga scintigraphy revealed a hot area on portion of the RV outflow patch. However, medical treatment was effective and the hot area was reduced. The omental transposition appeared to be very effective for treating the bacterial infection and Ga scintigraphy was useful for diagnosis of the infectious portion.
对一名32岁患有右心室流出道补片的男性患者进行了法洛四联症矫正手术。术后6天，他因耐甲氧西林金黄色葡萄球菌感染出现脓性分泌物。采用单切口闭合的网膜移位术治疗纵隔炎。再次手术后，他出现高热、连枷胸和脓性分泌物。因纵隔炎复发进行了再次手术，但术中发现感染仅累及包括右心室流出道补片在内的心脏。因此，制作了一块胸大肌瓣来治疗胸骨伤口感染。第二次手术后3个月他出院，恢复过程顺利。然而，他后来因高热再次入院。血培养显示为耐甲氧西林金黄色葡萄球菌。由于镓闪烁扫描显示右心室流出道补片部分有热点，我们怀疑纵隔炎复发。然而，药物治疗有效，热点缩小。网膜移位术似乎对治疗细菌感染非常有效，镓闪烁扫描对感染部位的诊断很有用。
