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[Commando Procedure for Rapidly Progressing Infective Endocarditis in Immunosuppressive State: Report of a Case]
Yuka Sueta1, Toshiro Kobayashi, Sarii Tsubone
1Departments of Surgery, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|September 22, 2023
Summary
A complex heart infection caused by MRSA was treated with the Commando procedure. This surgery, involving valve replacement and aortic repair, proved effective for this critical cardiac condition.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- A 68-year-old immunocompromised patient developed infective endocarditis.
- The infection was caused by methicillin-resistant Staphylococcus aureus (MRSA).
Observation:
- Echocardiography revealed an aortic annular abscess with shunt flow into the left atrium, indicating intervalvular fibrosa (IVF) infection.
- The patient experienced progressive heart failure, necessitating surgical intervention.
Findings:
- The patient underwent a Commando procedure, including aortic valve and anterior mitral leaflet resection.
- Mitral valve replacement with a bioprosthesis and reconstruction of the IVF and left atrial roof with a bovine pericardial patch were performed.
- A Bentall procedure was necessary due to extension of infection to the sinus of Valsalva and aortic root dilation.
Implications:
- The Commando procedure, despite high early mortality rates, can be an effective treatment for extensive MRSA infective endocarditis involving the aortic valve, IVF, and aortic root.
- Successful surgical management in this case highlights the potential for complex cardiac reconstructions in critically ill patients.
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