J Thorac Cardiovasc Surg 2008;136:533-534
© 2008 The American Association for Thoracic Surgery
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Australia
Received for publication December 23, 2007; accepted for publication January 13, 2008. * Address for reprints: Igor E. Konstantinov, MD, PhD, Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, G Block, Hospital Ave, Perth, WA 6009 Australia.
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Acute infective endocarditis of the mitral valve (MV) in noncompliant intravenous drug users presents a difficult problem. Although progressive sepsis despite appropriate antibiotic therapy necessitates prompt surgical intervention, the risk of prosthetic endocarditis after valve replacement is very high in this group of noncompliant patients. Excessive tissue damage and annular abscess, on the other hand, may prevent simple conventional repair. I refer to the procedure as reconstruction as opposed to repair, when 1/3 or more of the valve has to be removed. Reconstruction of the MV, as described here, could be a valuable alternative under these circumstances.
A 28-year-old man with a long history of intravenous drug use was admitted with fever and chills. Multiple blood cultures demonstrated Staphylococcus aureus. Echocardiography demonstrated a large, mobile vegetation straddling both leaflets of the MV and an abscess extending into the posterior MV annulus (
Figure 1, A and B). Prolapse of
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