Posterior leaflet P2-P1 transposition for mitral repair in a case of infective endocarditis

Infective endocarditis represents a pathological process associated with a high mortality. The dysfunction of cardiac valves and its consequent hemodynamic deterioration often requires urgent surgery. Tissue preservation and valve repair without a substitute material may be extremely difficult. Herein, the details are reported of a safe technique used to repair a mitral valve presenting with P1 destruction caused by pneumococcal endocarditis vegetation, associated with severe mitral regurgitation. A safe repair was achieved by performing a P2 to P1 transposition, after a subvalvular apparatus analysis, followed by annular plication and ring annuloplasty. The postoperative course was uneventful, and echocardiography at discharge showed excellent mitral valve competence. Sufficient evidence was provided to demonstrate that, in these cases, it is better to repair than to replace. Hence, the present technique should be considered, whenever possible, for mitral valve surgical repair in order to avoid substitute interposition in cases of infective endocarditis.