A Case of Infective Endocarditis on an Annuloplasty Ring following Mitral Valve Repair

(Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan)

Tatsuya Murakami Hiroki Kato Yutaka Makino
Infective endocarditis on an annuloplasty ring following mitral valve repair is rare. A 59-year-old man underwent emergency sextuple coronary artery bypass grafting and mitral annuloplasty with a 26mm ring for acute myocardial infarction and mitral regurgitation. Seven weeks later, he was readmitted complaining of abdominal pain and diarrhea. He experienced high-grade fever with chills associated with leukocytosis and elevation of C reactive protein after gastroduodenal endoscopy. Although antibiotics were administered intravenously for several weeks, the fever persisted. Transesophageal echocardiography revealed vegetations on the mitral annuloplasty ring. Infective endocarditis was diagnosed as the culprit of the unknown fever and urgent surgery was indicated. Following redo median sternotomy, the heart was meticulously dissected out. On cardiopulmonary bypass with the heart arrested, left atriotomy was carried on the interatrial groove. Because of the small left atrium, Dubost incision was added for better mitral valve exposure. The infected annuloplasty ring was excised with the vegetations. The mitral valve was easily repaired because the valve leaflets had minimal changes except a small perforation at the base of the posterior middle scallop. After thorough debridement of the mitral valve, a glutaraldehyde-treated autologous pericardial strip was sutured along the annulus as a posterior pericardial band. Culture of the vegetation proved negative. His postoperative course was uneventful. He has been doing well for more than two and a half years with trivial mitral regurgitation and no recurrence of infection. According to the American Heart Association guidelines, endocarditis prophylaxis is not usually needed for gastrointestinal endoscopy, but is optional for high risk patients including those with prosthetic cardiac valves. Such a diagnostic procedure should be avoided soon after the application of an annuloplasty ring and if necessary, antiinfective prophylaxis may be indicated.
@Jpn. J. Cardiovasc. Surg. 37: 136-139 (2008)