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[Conservative surgery in the treatment of infectious mitral valve insufficiency]
1Service de cardiologie, hôpital Tenon, Paris.
Abstract:
In order to analyse the results of conservative mitral valve surgery in the treatment of mitral regurgitation due to infective endocarditis, the authors reviewed the cases of 48 patients operated between 1974 and April 1993 (36 operations having been performed after 1989, a period during which only 3 patients underwent mitral valve replacement for the same indication). Thirty-four patients were operated after sterilisation of the infective endocarditis, and 14 patients were treated during the active phase. There were 32 men and 16 women with an average age of 45 +/- 13 years. In two thirds of the cases, the causative organism was a streptococcus. Half of the patients were operated during the acute stage because of their poor haemodynamic status, 5 because of residual bacterial vegetations after one or more embolic events and two because of the infection itself. On the other hand, patients were operated after the infective phase because of severe mitral regurgitation, responsible for severe symptoms (NYHA Class III) in 16 cases. From the anatomical point of view, the peroperative finding of 14 patients operated in the acute phase included dilatation of the annulus (N = 9), ruptured chordae (N = 9), perforation (N = 8) or vegetations (N = 8); in the patients operated later, the incidence of perforation and vegetations was much lower (20%) whereas dilatation of the annulus was almost constant (91%).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Conservative mitral valve surgery is effective for infective endocarditis, particularly after infection control. This approach showed good results in patients with mitral regurgitation, even in acute phases.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Valvular Heart Disease
Background:
- Infective endocarditis frequently causes mitral regurgitation.
- Mitral valve replacement is often considered the standard treatment.
- Conservative surgery outcomes for this condition require further analysis.
Purpose of the Study:
- To analyze the results of conservative mitral valve surgery for mitral regurgitation secondary to infective endocarditis.
- To compare surgical approaches during active infection versus after sterilization.
Main Methods:
- Retrospective review of 48 patients undergoing mitral valve surgery between 1974 and April 1993.
- Categorization of patients into those operated during active infection (14) versus after sterilization (34).
- Analysis of pre-operative conditions, intra-operative findings, and outcomes.
Main Results:
- A shift towards conservative surgery after 1989 (36/39 cases) compared to earlier periods (3/15 cases).
- Patients operated during the acute phase often presented with annulus dilatation, ruptured chordae, perforation, or vegetations.
- Patients operated after infection sterilization predominantly had annulus dilatation (91%) with lower rates of perforation and vegetations (20%).
Conclusions:
- Conservative mitral valve surgery can be a viable option for treating mitral regurgitation caused by infective endocarditis.
- Surgical strategy may differ based on whether the operation is performed during the active infectious phase or after sterilization.
- Further research is needed to fully elucidate long-term outcomes of conservative approaches.