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Technique to treat extensive abscesses in double valve replacement for prosthetic valve endocarditis

Michihito Nonaka1, Atsushi Iwakura, Kazuo Yamanaka

  • 1Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan. mnonaka0725@hotmail.co.jp

The Journal of Heart Valve Disease
|November 15, 2013
PubMed

Insights

Prosthetic valve endocarditis (PVE) can be surgically treated by reinforcing the intervalvular fibrous body and using anchoring sutures. This innovative approach helps isolate abscesses and reduce recurrent infection risk in complex cardiac cases.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Biomaterials in Medicine

Background:

  • Native valve endocarditis necessitates valve replacement, but prosthetic valve endocarditis (PVE) poses a significant surgical challenge.
  • Prosthetic valve endocarditis (PVE) recurrence is a major concern, especially when abscesses compromise cardiac structures.

Observation:

  • A patient with PVE developed a large aortic annular abscess extending to the mitral annulus nine months post-double valve replacement.
  • Surgical intervention involved excising the infected mitral valve, debriding the abscess, and reinforcing the intervalvular fibrous body with a xenopericardial patch.

Findings:

  • The xenopericardial patch successfully reinforced the affected annuli and isolated the abscessed area, preventing further blood flow contamination.
  • 'Anchoring' sutures were employed externally through the aortic root to accommodate the reconstructed annulus's fragility during valve implantation.

Implications:

  • This surgical technique, combining intervalvular fibrous body reinforcement and anchoring sutures, offers a promising alternative for treating complex PVE.
  • The described method effectively reduces the probability of recurrent endocarditis in patients with extensive annular abscesses.
  • Successful patient recovery with no signs of recurrent infection highlights the efficacy of this reconstructive approach.

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