PMID- 8901734
OWN - NLM
STAT- MEDLINE
DCOM- 19961206
LR  - 20041117
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 94
IP  - 9 Suppl
DP  - 1996 Nov 1
TI  - Mitral valve reconstruction for active and healed endocarditis.
PG  - II133-8
AB  - BACKGROUND: Mitral valve reconstruction rather than replacement for mitral 
      insufficiency offers a number of well-accepted benefits. However, the feasibility 
      and results of reconstruction for endocarditis remain largely unknown. METHODS 
      AND RESULTS: We reviewed 22 consecutive patients referred to the Thoracic 
      Surgical Service at the University of Michigan from January 1, 1991, through 
      October 1, 1995, who underwent mitral valve reconstruction for mitral 
      insufficiency caused by isolated mitral valve endocarditis. Mean age, 
      preoperative ejection fraction, and New York Heart Association (NYHA) functional 
      class were 53 +/- 15 years, 54 +/- 12%, and 3.2 +/- 0.8, respectively. Seven 
      patients had early operation because of septic embolization, persistent 
      infection, or refractory heart failure. Fifteen were cured of infection and were 
      operated on for progressive symptomatic heart failure and left ventricular 
      dilation. Preoperative transesophageal echocardiograms demonstrated severe mitral 
      insufficiency in 20 patients. Valvular pathology noted at operation included 
      annular (6 patients) or leaflet calcification (2), chordal rupture (13), leaflet 
      vegetations (11), annular abscess (3), annular dilation (18), flail leaflet (12), 
      leaflet prolapse (17), chordal shortening (1), and mitral stenosis (1). Mitral 
      valve reconstruction included debridement of infected tissue and implantation of 
      an annuloplasty ring (20 of 22 patients), as well as other complex techniques. 
      Postrepair transesophageal echocardiograms demonstrated mild mitral insufficiency 
      in 6 patients and none in 16 patients. There were no operative or in hospital 
      deaths. Mean follow-up was 20 +/- 14 months. One late death occurred at 30 
      months. At follow-up, 90% of surviving patients were in NYHA functional class I 
      or II. CONCLUSIONS: Mitral valve reconstruction for active or healed endocarditis 
      can be performed with low operative morbidity and mortality and yields excellent 
      functional results. Although longer-term follow-up is mandatory, these data 
      support strong consideration of mitral valve reconstruction rather than mitral 
      valve replacement for mitral insufficiency secondary to endocarditis.
FAU - Pagani, F D
AU  - Pagani FD
AD  - Department of Surgery, University of Michigan Medical Center, Ann Arbor 
      48109-0344, USA.
FAU - Monaghan, H L
AU  - Monaghan HL
FAU - Deeb, G M
AU  - Deeb GM
FAU - Bolling, S F
AU  - Bolling SF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Adult
MH  - Aged
MH  - Embolism/etiology
MH  - Endocarditis/complications/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*surgery
EDAT- 1996/11/01 00:00
MHDA- 1996/11/01 00:01
CRDT- 1996/11/01 00:00
PHST- 1996/11/01 00:00 [pubmed]
PHST- 1996/11/01 00:01 [medline]
PHST- 1996/11/01 00:00 [entrez]
PST - ppublish
SO  - Circulation. 1996 Nov 1;94(9 Suppl):II133-8.