Mitral reconstruction in patients with infective endocarditis]

Between June 1992 and October 1993, 5 patients with infective endocarditis in native mitral valve underwent open heart surgery. The patients ranged in age from 51 to 64 years and were all males. According to NYHA functional classification, 4 patients were class II and one was class III. Surgery was indicated because of hemodynamic deterioration (2 pts), echocardiographic mobile vegetation with or without previous emboli (2 pts) and both condition (1 pt). Before surgery the patients were afebrile and had negative serum CRP and negative blood cultures for at least one week after adequate medical treatment. The leaflet lesions found in the 5 patients were vegetation (2 pts), perforation (1 pt), calcification (1 pt) and thickening (2 pts). The chordal lesions found were rupture (5 pts) and thickening (1 pt). The infective lesions did not extend to the annulus. The mitral leaflets, including all apparently infectious lesions, were resected in a V-shaped fashion and then valve reconstruction was performed. The resected parts were sutured together with anchoring chordae. The annuloplasty with Teflon-tapes was also added. Postoperatively, all 5 patients showed a dramatic improvement in hemodynamics and endocarditis did not recur during 22 to 38 months of follow-up. The patients who received the repair did not require Warfarin. This study shows that mitral valve repair is an acceptable operation in patients with infective endocarditis, giving the patients better quality of life than mitral valve replacement when (1) infectious lesion are limited to mitral leaflet and chordae, (2) there is no severe calcification of the mitral valve, (3) the infection is healed by the adequate antibiotic therapy.