[A successful case report of mediastinitis and sternal infection due to MRSA after correction for tetralogy of Fallot with omental transposition and major pectoral muscle flap].

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.