Right-sided infective endocarditis: valvuloplasty, valvectomy or replacement

Fifteen patients were operated upon for right-sided infective endocarditis after failing medical treatment. The infection was localized sufficiently to allow reconstruction without valve replacement in 9 patients (60%). Extensive annular and tri-leaflet infections (2 pts.) or significant residual regurgitation (2 pts.) prohibited reconstruction in four patients. In the remaining two patients, the relatively low intracardiac pressures allowed isolated tricuspid or pulmonary valvectomy (1 each). The single hospital mortality (6.7%) resulted from a missed secondary lesion during reparation. Late recurrence or replacement in the valvuloplasty group was 0 in 9 patients (0%) while late replacement or death from infection occurred in 2 of 5 patients (40%) in the valvectomy and replacement groups. Right-sided endocarditis is frequently amenable to reconstruction without late recurrence. Its advantage is in establishing satisfactory hemodynamics without prosthetic replacement. Alternatively, isolated valvectomy can be occasionally performed. Simultaneous or staged prosthetic replacement is frequently required for early (associated left-sided infection) and late (right-sided dilation) hemodynamic reasons.