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How to treat an infection on the chest after a valve replacement?

Q: My mother had one heart valve replaced with a prosthetic valve eight years back. Later she had a boil on her chest right on the stitches which the doctor said was a sinus due to sternal wire in her bones. The sternal wire was removed but the wound has not filled and has taken the shape of a hole through which pus has started coming out. The doctors operated again but the problem remained. They said that the wound will heal on its own after some time, but even after six months the problem is still the same. We have done all tests like CT scan, X-rays, pus culture, other pus tests, blood sugar and biopsy, but all are normal and there is no bacterial or fungal infection. Kindly advise.

A:Infection in the breast bone, ribs or cartilages of the chest after any open heart surgery occurs in 2-5% of patients depending on the clinical status of the patient, presence or absence of diabetes and other technical reasons. This infection in a small percentage of cases can be very difficult to eradicate as the bacteria lodge in inaccessible areas of the bone which do not have any adequate blood supply so that the antibiotics cannot reach them. It is almost akin to the situation of terrorists hiding in the society. No matter what you do, it becomes nigh impossible to eradicate them from every nook and corner. Similarly, antibiotics take care of major quantum of infection but can not remove just that last bit of germ lingering in a remote corner of the wound. Therefore, some times, these bone infections are very recalcitrant and difficult to eradicate. One has to be very patient and not lose one’s will power. I may mention here that in these situations body’s immunity level and nutritional status too play a very important role. I would therefore advise to be under regular follow up of your treating cardiac surgeon with a clear understanding that your problem may take a long time to heal and may require multiple minor operations and courses of antibiotics. I hope I have answered your queries but if you have any other, please feel free to contact us and it shall be our pleasure to answer them.

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