Treatment of mediastinitis after heart transplantation.

Mediastinal infection carries a high mortality in any heart surgery patient. The risks are even greater after heart transplantation. We present two cases of mediastinitis in heart transplant patients. The first patient was successfully treated with closed mediastinal irrigation. The second patient was initially treated with closed mediastinal irrigation, developed recurrent infection, and subsequently responded to a muscle flap operation. A review of the literature and our own experience suggest that muscle flaps should be applied earlier in heart transplant recipients with severe or recurrent mediastinal infections.