Cardiac
infections after operations are infrequent but, when present, are often fatal. The 14 autopsied patients in whom purulent
pericarditis developed after thoracic operations over an 88 year period at The Johns Hopkins Hospital were studied. Purulent
pericarditis developed after cardiac operations in 10 and after pulmonary resections in 4. In 12 of the 14 cases the pericardial sac had been opened. Associated postoperative
infection, present in 13 patients, included
mediastinitis in 7 and
empyema in 3. Staphylococcus was the
infection organism in half of the patients. Associated cardiac
infection, including
endocarditis, myocardial
abscess, and graft
infection, was present in 5 (36 per cent) patients. Death occurred within 2 months of operation in 11 (79 per cent) patients; it was due to
infection in 9,
cardiac tamponade in 4, and arrhythmias and
heart failure in one. The diagnosis of purulent
pericarditis was made before death in only 5 (36 per cent) cases, in part owing to masking of the usual signs of
pericarditis in the postoperative patient. Since the introduction of
antibiotics, the over-all incidence of purulent
pericarditis has decreased. However, pericardial
infection after
thoracotomy has increased tenfold, and patients undergoing cardiac operations in particular provide a new and increasing population at risk for this disease.