[HSF] Endocarditis with splenic infarct

[prasannasimha]

This is a useful method.

Prasanna

Commissuroplasty: a method of valve repair for mitral and tricuspid 
endocarditis

* *

*David T. M. Lai, FRACS^a 
<http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-3XXCYV5-1H&_user=5680661&_coverDate=11%2F30%2F1999&_rdoc=43&_fmt=summary&_orig=browse&_srch=doc-info%28%23toc%234877%231999%23999319994%23142671%23FLA%23display%23Volume%29&_cdi=4877&_sort=d&_docanchor=&view=c&_ct=130&_acct=C000054502&_version=1&_urlVersion=0&_userid=5680661&md5=b9fc677e117730b7245722fbb6fd21b8#aff1> 
and Richard B. Chard, FRACS^Corresponding Author Contact Information 
<http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-3XXCYV5-1H&_user=5680661&_coverDate=11%2F30%2F1999&_rdoc=43&_fmt=summary&_orig=browse&_srch=doc-info%28%23toc%234877%231999%23999319994%23142671%23FLA%23display%23Volume%29&_cdi=4877&_sort=d&_docanchor=&view=c&_ct=130&_acct=C000054502&_version=1&_urlVersion=0&_userid=5680661&md5=b9fc677e117730b7245722fbb6fd21b8#m4.cor*>^, 
^E-mail The Corresponding Author <mailto:chardric at netspace.net.au>^, ^a 
<http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T11-3XXCYV5-1H&_user=5680661&_coverDate=11%2F30%2F1999&_rdoc=43&_fmt=summary&_orig=browse&_srch=doc-info%28%23toc%234877%231999%23999319994%23142671%23FLA%23display%23Volume%29&_cdi=4877&_sort=d&_docanchor=&view=c&_ct=130&_acct=C000054502&_version=1&_urlVersion=0&_userid=5680661&md5=b9fc677e117730b7245722fbb6fd21b8#aff1> 
*
^a Department of Cardiothoracic Surgery, Westmead Hospital & Royal 
Alexandra Hospital for Children, Sydney, Australia
Accepted 8 April 1999. Available online 19 November 1999.



Abstract

/Background/. We describe our experience with a technique of cusp 
commissuroplasty to reconstruct atrioventricular valves damaged by 
endocarditis of the commissure and adjacent cusps.

/Methods/. We operated on 3 patients with mitral endocarditis and one 
patient with previous tricuspid endocarditis. Infected leaflet tissue 
was excised from each side of the commissure, leaving a defect between 
one quarter and one third of the valve area. Using the technique of 
valve commissuroplasty, leaflet remnants were reapposed at the cut edges 
to obliterate the commissure. The residual Image-shaped defect between 
the apposed leaflets and annulus was either closed directly or patched 
with pericardium, depending on the size of the defect.

/Results/. Constructing unicommissural mitral and bicuspid tricuspid 
valves restored leaflet continuity. One patient was lost to follow-up. 
Postoperative echocardiography performed at a mean interval of 14.7 
months showed competent and nonobstructed valves. There was no recurrent 
endocarditis at a mean follow-up time of 15.7 months.

/Conclusions/. The technique of cusp commissuroplasty can be used to 
reconstruct atrioventricular valves that have been damaged by 
endocarditis of the commissure and adjacent cusps.

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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