[HSF] Endocarditis with splenic infarct

[rwmfglycar at aol.com]

A word of warning about the use of glut to impart strength to suspect tissues. I had one experience in which I soaked aortic wall tissue that I was absolutely sure was not infected and had the experience of an aneurysm developing some months later in the treated part of the native aorta adjacent to the completely intact xenograft pericardial patch. I was obviously in error in assuming that the aorta had been only mildly affected by the inflammation adjacent to the removed infected tissue. It was apparently already sufficiently weakened that glutaraldehyde did it no good. The suture line was completely intact, but the native aortic wall had thinned out into an aneurysm.The alternative explanation that the glut had actually damaged the treated aorta seemed to me unlikely.Yours
Bob
PS I chuckle when I think of IRB's and Regulators faced with wild and woolly surgeons using glut and betadine and other stuff  without asking their permission.


-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Sat, 2 Jun 2007 6:08 pm
Subject: Re: [HSF] Endocarditis with splenic infarct



Erdinc,
 Those are some well thought out questions regarding repair of the  SBE 
itral.  My criteria for repairing are actually quite simple.  Can  I 
econstruct 
 competent valve after all of the infection has been mercilessly  removed?  
or me, this has included autologous pericardial patch repair of  the anterior 
eaflet, triangular resection of the anterior leaflet, quadrangular  resection 
ith or without sliding leaflet plasty of the posterior leaflet.   
ommissural infections can also be reconstructed with sliding leaflet plasty and  
commissuroplasty.  Annular abscesses are debrided and then covered with  
utologous 
ericardium with Bioglue injected underneath the patch.  I think  Prasanna's 
uggestion to paint fragile, suspect areas with gluteraldehyde is  excellent.  
 don't recall repairing a bileaflet SBE infection, but I  certainly wouldn't 
esitate if the patient would be left with a competent valve  having a good 
epth of coaptation.  The thing that prevents me from  repairing an SBE mitral 
s finding small vegetations scattered in several  different areas of the 
eaflets. 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 
epairing a valve.
al

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