[HSF] Endocarditis with splenic infarct

[Hgrmd at aol.com]

Erdinc,
  Those are some well thought out questions regarding repair of the  SBE 
mitral.  My criteria for repairing are actually quite simple.  Can  I reconstruct 
a competent valve after all of the infection has been mercilessly  removed?  
For me, this has included autologous pericardial patch repair of  the anterior 
leaflet, triangular resection of the anterior leaflet, quadrangular  resection 
with or without sliding leaflet plasty of the posterior leaflet.   
Commissural infections can also be reconstructed with sliding leaflet plasty and  
commissuroplasty.  Annular abscesses are debrided and then covered with  autologous 
pericardium with Bioglue injected underneath the patch.  I think  Prasanna's 
suggestion to paint fragile, suspect areas with gluteraldehyde is  excellent.  
I don't recall repairing a bileaflet SBE infection, but I  certainly wouldn't 
hesitate if the patient would be left with a competent valve  having a good 
depth of coaptation.  The thing that prevents me from  repairing an SBE mitral 
is finding small vegetations scattered in several  different areas of the 
leaflets. Other than maybe fungus, I wouldn't consider  the etiologic organism a 
contraindication to repair.  Certainly, I have  successfully repaired staph SBE. 
Size of the vegetation and embolic history  would also not prevent me from 
repairing a valve.
Hal



************************************** See what's free at http://www.aol.com.