Surgical Experience of Reconstruction of the Annular and the Intervalvular Fibrous Skeleton for Active Infective Endocarditis.
10.4070/kcj.2002.32.11.996
- Author:
Ki Ick SUNG
1
;
Pyo Won PARK
Author Information
1. Department of Thoracic and Cardiovascular Surgery of Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wizski@hanmail.net
- Publication Type:Original Article
- Keywords:
Endocarditis;
Abscess;
Heart valves;
Surgery
- MeSH:
Abscess;
Atrioventricular Block;
Cerebral Hemorrhage;
Endocarditis*;
Follow-Up Studies;
Heart Valves;
Hemorrhage;
Hospital Records;
Humans;
Intracranial Embolism;
Korea;
Mediastinitis;
Mortality;
Postoperative Complications;
Recurrence;
Retrospective Studies;
Skeleton*
- From:Korean Circulation Journal
2002;32(11):996-1003
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: The treatment for active infective endocarditis (IE) with a paravalvular abscess results in a high morbidity and mortality. Recently, some good results with a reconstruction of the annulus or fibrous skeleton in active IE have been published. However, there are few papers on this subject reported in Korea. SUBJECTS AND METHODS: The hospital records of 29 patients who had undergone surgery for active IE with a paravalvular abscess from Mar. 1995 to Jun. 2002 were retrospectively reviewed. The mean age was 43.8 +/-16.9 (range : 13-69) years. The NYHA functional class was either III or IV in 11 cases (37.9%) and prosthetic valve endocarditis was present in 8 cases (27.6%). The mean duration of preoperative antibiotic treatment was 13.3+/-11.9 days. RESULTS: The aortic annulus was reconstructed in 7 patients, an aortic annulus+the aorto-mitral continuity was done in 8 cases, an aortic annulus+mitral annulus+aorto-mitral continuity was done in 1 case, and a mitral annulus was done in 13 cases. There was one (3.4%) early death due to a non-cardiac cause. The postoperative complications were as follows : additional surgery due to bleeding in 3 cases (10.3%), mediastinitis in 1 case (3.4%), a complete atrioventricular block in 1 case (3.4%), and a cerebral hemorrhage in 2 cases (6.9%) who had had a history of cerebral embolism. All patients (100%) were followed up with a mean follow-up duration of 22.0+/-19.2 months. There was 1 late death (3.6%) and 2 additional procedures including one recurrence. CONCLUSION: Reconstruction of the annulus and intervalvular fibrous skeleton in these patients showed a relatively low morbidity and mortality, and recurrence rate. Therefore, it is recommended that these patients be treated aggressively.
