[HSF] Endocarditis with splenic infarct

[prasannasimha]

Options depends on the intactness of the veil territory.

If the veil is to be excised, excise P1 . Place a slide incision on the 
A1only if required and excise  part of A1 if involved by a kissing 
lesion... Place a Kay type stitch on the annulus and exclude the P1. 
Evaluate the other areas Place a ring now.

If the excised point is a wedge with the veil intact, eccentric 
imbrication of  P1can be done just like a P2 plication or a pericardial 
patch and Goretex suspension of the patched area.
If the veil is not intact then since their is no support in that area, a 
Kay type exclusion will be required.

You will have to flexible in your approach.

Healed vegetations behave like any other case recurrent endocarditis 
depends on residual MR and the inciting cause  removal and patient 
education of SBE prophylaxis. (This would not be altered and in fact 
would be worse with a prosthetic valve).
In active endocarditis recurrence is dependent on debridement and use of 
a pericardial strip annuloplasty is supposed to decrease chances of 
recurrent endocarditis though many use a prosthetic ring with success. 
In the setting of endocarditis (non-healed) I use the regular ring that 
I make of Goretex but will use a Glutaraldehyde treated Pericardial 
strip if there is active endocarditis.
The last photo I had put up had healed vegetations which were in fact 
calcified and so I used a Goretex ring. Remember though that a healed 
vegetation can still have viable bacteria  entrapped inside its core.
Prasanna

nand kejriwal wrote:
> Hal
>
> Did you find any difference in recurrence of endocarditis in patients 
> whose
> vegetation was +ve for organisms as compared to those with sterile veges.
>
> Hal & Prasanna
>
> If you have to excise the entire P1, what repair would you do - annulus
> reconstruction, suturing P2 to A1 and annuloplasty?
>
> nand
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