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[Mitral valvuloplasty during the acute phase of endocarditis]
J F Fuzellier1, C Acar, V A Jebara
1Département de chirurgie cardiovasculaire, hôpital Broussais, Paris.
Abstract:
Thirty-five patients were operated in the acute phase of mitral valve endocarditis between 1986 and 1991. The surgical indications were hemodynamic (22), echocardiographic (9), embolic (2) and infectious (2). There were pre-existing valve lesions in 45% of cases. The causal organism was identified in 90% of cases: streptococcus (19), staphylococcus (9) and Gram negative bacilli (4). Preoperative antibiotic therapy was prescribed for an average of 18 days. The aortic valve was infected in 9 patients and tricuspid valve in 1 patient. The mitral lesions were: abscess (11), vegetations (11), perforations (16), and ruptured chordae tendinae (22). All patients underwent Carpentier's mitral valvuloplasty. The operative mortality was 5.7% (2 patients). Early reoperation was required in 1 case. Follow-up was possible in 96% of cases for an average of 23 months. No recurrences of endocarditis were observed. One patient was reoperated and 3 died. All the others were in Classes I and II of the NYHA. None had significant mitral regurgitation or stenosis. These results show that mitral valvuloplasty is possible in the acute phase of endocarditis in 90% of cases. The mortality and morbidity are low and long-term results are stable.
Insights
Mitral valvuloplasty is a viable treatment for acute mitral valve endocarditis, showing low operative mortality and stable long-term results. This surgical approach is effective in managing complex valve lesions and preventing recurrence.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Context:
- Acute mitral valve endocarditis presents significant surgical challenges.
- Pre-existing valve lesions and diverse causal organisms complicate management.
- Surgical intervention is often necessitated by hemodynamic instability, echocardiographic findings, or embolic/infectious complications.
Purpose:
- To evaluate the efficacy and outcomes of mitral valvuloplasty in patients with acute mitral valve endocarditis.
- To assess operative mortality, morbidity, and long-term results of this surgical technique.
Summary:
- Thirty-five patients with acute mitral valve endocarditis underwent Carpentier's mitral valvuloplasty between 1986 and 1991.
- Surgical indications included hemodynamic compromise (22), echocardiographic abnormalities (9), and embolic/infectious causes (4).
- Operative mortality was 5.7% (2 patients), with one early reoperation. Follow-up in 96% of cases (average 23 months) showed no endocarditis recurrence, with most patients in NYHA Class I/II and no significant mitral regurgitation or stenosis.
Impact:
- Mitral valvuloplasty is feasible in 90% of acute mitral valve endocarditis cases.
- The procedure demonstrates low mortality and morbidity with stable long-term outcomes.
- This study supports mitral valvuloplasty as a safe and effective treatment for acute mitral valve endocarditis.