Background: Deep sternal wound infection after heart surgery is rare but devastating complication associated with significant morbidity, mortality and cost. Management of a sternal osteomyelitis is still difficult and is a subject of controversy. In this paper, we report a case with sternal osteomyelitis communicated to anterior mediastinum that was successfully treated with partial sternal resection and pectoralis major muscular flap reconstruction. Case Report: A 28-year-old woman underwent mitral valve replacement due to early prosthetic valve endocarditis. One month later purulent drainage developed at sternotomy incision and wound culture revealed Methicillin resistant staphylococcus aureus This organism was also responsible for prosthetic valve endocarditis. Sinographic fistulogram showed a mediastinal cutaneous fistula which is communicated to anterior mediastinum that the tract was lay down along the epicardial pacemaker leads which had been left in mediastinum. The patient was successfully treated with partial sternal resection and pectoralis major muscular flap reconstruction. Conclusions: In patients at risk for native or prosthetic valve endocarditis, to eradicate and remove the potential focus for bacteremia is mandatory. Mediastinal cutaneous fistula could potentially cause bacteremia that had possible potential risk for prosthetic valve endocarditis. The abandoned epicardial pacemaker leads may facilitate development of mediastinal fistula and sternal osteomyelitis. Partial sternal resection and muscle flap reconstruction can be safe and an effective for the patient who had suffered from and had tendency for infective endocarditis.

Keywords: Heart Valve Prosthesis, Endocarditis, Fistula, Diagnostic Imaging, Surgery