A Case of Mitral Valve Plasty without Autologous Pericardium for Active Infective Endocarditis
10.4326/jjcvs.40.72
- VernacularTitle:広範に弁尖が破壊された活動期感染性心内膜炎に対して心膜補填なしに僧帽弁形成術を施行した1例
- Author:
Atsushi Shimizu
;
Hiroyuki Nakajima
;
Hiroaki Osada
;
Atsushi Nagasawa
;
Masahisa Kyogoku
- Publication Type:Journal Article
- Keywords:
infective endocarditis;
mitral valve plasty;
commisural leaflet disease
- From:Japanese Journal of Cardiovascular Surgery
2011;40(2):72-76
- CountryJapan
- Language:Japanese
-
Abstract:
In recent treatment of mitral regurgitation due to active infective endocarditis, significant attempts have been made to repair as much of the mitral valve as possible. In cases where the leaflet is damaged extensively because of infection, valve repair generally becomes difficult unless the defect is reinforced by glutaric aldehyde-preserved autologous pericardium. We report a case in which mitral valve plasty for mitral regurgitation was performed under these circumstances. A 27-year-old man was admitted to our hospital because of headache and persistent fever. Transthoracic echocardiography revealed a 13-mm friable vegetation attached to the anterior leaflet of the mitral valve with severe mitral regurgitation. Urgent surgery was performed based on a diagnosis of active infective endocartitis. After cardiopulmonary bypass was performed and the aorta was cross-clamped, a left atriotomy was carried out on the interatrial groove. Much vegetation was attached to the damaged mitral leaflet from A3 to P3, and prolapse of the commissural leaflet was observed. The vegetation and damaged leaflet were then removed. Removal of the superficial vegetations enabled preservation of more than half of the A3. The valve was repaired by the resection-suture technique without using the autologous pericardium, as glutaric aldehyde solution was not available. Mitral annuloplasty using a 28-mm physio ring was performed thereafter. The postoperative course was uneventful and without any residual regurgitation. Nine months after surgery, no recurrence of infection or mitral regurgitation was not observed.
