Reconstruction of mitral valve chordae and leaflets with one piece of autologous pericardium in extensively destructed m
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CASE REPORT
Reconstruction of mitral valve chordae and leaflets with one piece of autologous pericardium in extensively destructed mitral valve due to active infective endocarditis Toshiaki Ito • Atsuo Maekawa • Sadanari Sawaki • Genyo Fujii • Satoshi Hoshino • Yasunari Hayashi
Received: 23 June 2012 / Accepted: 9 December 2012 Ó The Japanese Association for Thoracic Surgery 2012
Abstract A 20-year-old female patient underwent urgent surgery for extensive mitral valve endocarditis. All marginal chordae and rough zone of A3 leaflet, posterior commissure leaflet, and P3 leaflet down to the annulus became defective after complete debridement of infected tissues. After annular plication, defective leaflets and chordae were reconstructed with a piece of triangular shaped autologous pericardium. Top of the pericardium was directly attached to the posterior papillary muscle, side edges to remnant leaflets, and the base to the annulus, thus substituting for chordae and leaflets at once. No mitral regurgitation was observed during 3 years of follow-up after the operation. Keywords repair
Endocarditis Pericardium Mitral valve
Introduction Mitral valve plasty is more desirable than valve replacement for active infectious endocarditis (IE), especially in young patients. However, it is sometimes technically demanding when the infection is extensive and radical resection of valve tissue is necessary. We report a young patient who underwent successful mitral valve plasty for extensive active IE with a simple technique using autologous pericardium.
T. Ito (&) A. Maekawa S. Sawaki G. Fujii S. Hoshino Y. Hayashi Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya 453-8511, Japan e-mail: [email protected]
Case A 20-year-old female college student was admitted to our hospital in January 2009 complaining of high fever and headache. She had no particular past medical history. Bacterial meningitis was first suspected, but finding of spinal fluid tap was negative. Brain MRI revealed multiple small infarctions. Echocardiography showed moderate mitral regurgitation and vegetation about 1 cm in diameter attached to the anterior leaflet of the mitral valve. Blood culture was positive for Streptococcus gordonii. She was diagnosed as having active IE. Antibiotics therapy with 24 million units of penicillin per day was started, but the size of vegetation gradually increased on serial echocardiography and the grade of regurgitation became severe. Brain hemorrhage in left posterior lobe occurred 10 days after the admission with neurological sign of partial defect of visual field. Urgent surgery was performed because of progressive heart failure and uncontrollable infection on 17th hospital day. Surgical findings The chest was opened via median sternotomy with limited skin incision. Cardiopulmonary bypass was achieved by standard aortic and bicaval cannulation. The mitral valve was exposed using trans-septal approach under cardioplegic arrest. Large vegetat
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