Mitral Valvuloplasty for the Treatment of Infective Endocarditis and Mitral Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANGYi ,  XIONGHui , XUJian-ping , WANGWei , SUNHan-song , SONGYun-hu , WANGXiao-qi , GUOHong-wei , HUXiao-peng

Department of Surgery, Fu Wai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

XIONGHui, Email: dr.xionghui@gmail.com

Keywords：

Mitral valvuloplasty; Infective endocarditis; Mitral regurgitation

DOI：

10.7507/1007-4848.20140169

Video：

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Objective To investigate clinical outcomes of mitral valvuloplasty (MVP)for the treatment of infective endocarditis (IE)and mitral regurgitation (MR). Methods From March 2002 to January 2012, 33 patients with IE and MR underwent MVP in Fu Wai Hospital. There were 23 male and 10 female patients with their age of 10-67 (35.7±17.8)years. Thirteen patients had previous cardiac anomalies. Preoperatively, there were 5 patients with mild MR, 15 patients with moderate MR and 13 patients with severe MR. There were 5 patients in New York Heart Association (NYHA)functional classⅠ, 23 patients in classⅡ, 4 patients in classⅢ and 1 patient in classⅣ. All the patients received MVP including 14 patients received MVP in active phase of IE. Concomitantly, 6 patients received aortic valve replacement, 5 patients received tricuspid valvuloplasty, 1 patient received coronary artery bypass grafting, 1 patient received resection of left atrial myxoma and 1 patient received repair of aortic sinus aneurysm. Surgical procedures included pericardial patch closure of leaflet perforation in 5 patients, leaflet excision and suturing in 17 patients, double-orifice method in 3 patients, chordae transfer and artificial chordae implantation in 5 patients, and annuloplastic ring implantation in 15 patients. Results One patient died of acute myocardial infarction 7 days after the operation. All other 32 patients were successfully discharged. Echocardiography before discharge showed left ventricular end-diastolic diameter (LVEDD, 48.9±7.6 mm)and left atrial diameter (LAD, 31.7±7.4 mm)were significantly smaller than preoperative values (P=0.000). Thirty-two patients were followed up for 6-125 (73.0±38.6)months. There was no death, IE recurrence, bleeding or thromboembolism during follow-up. One patient received mitral valve replacement for mitral stenosis 3 years after discharge. There were 25 patients in NYHA func-tional classⅠ, 5 patients in classⅡand 2 patients in classⅢ. There were 4 patients with mild MR, 1 patient with moderate MR, and 26 patients had no MR. One patient had faster mitral inflow at diastolic phase (1.7 m/s). One patient had moderate aortic regurgitation. LVEDD and LAD during follow-up were not statistically different from those before discharge. Left ventricular ejection fraction during follow-up was significantly higher than that before discharge (60.9%±6.6% vs. 57.5%±6.7%, P=0.043). Conclusion MVP is a reliable surgical procedure for patients with IE and MR, and can significantly reduce left atrial and left ventricular diameter and improve cardiac function postoperatively.

Citation： CHANGYi, XIONGHui, XUJian-ping, WANGWei, SUNHan-song, SONGYun-hu, WANGXiao-qi, GUOHong-wei, HUXiao-peng. Mitral Valvuloplasty for the Treatment of Infective Endocarditis and Mitral Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 593-597. doi: 10.7507/1007-4848.20140169 Copy

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2.	张尔永,石应康,程述森,等. 原发性感染性心内膜炎瓣膜损害的外科治疗. 中国胸心血管外科临床杂志,1999,6(2):22-24.
3.	杨新伟,王志农,徐志云,等. 二尖瓣脱垂合并感染性心内膜炎的手术治疗. 第二军医大学学报,2009,30(2):133-136.
4.	Moreillon P,Que YA. Infective endocarditis. Lancet,2004,363(9403):139-149.
5.	López J,Revilla A,Vilacosta I,et al. Age-dependent profile of left-sided infective endocarditis:a 3-center experience. Circulation,2010,121(7):892-897.
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7.	Chambers HF. Transesophageal echocardiography in endocarditis. Chest,1994,105(2):333-334.
8.	朱晓东,张宝仁,主编.心脏外科学. 北京:人民卫生出版社,2007. 800-801.
9.	Shimokawa T,Kasegawa H,Matsuyama S,et al. Long-Term outcome of mitral valve repair for infective endocarditis. Ann Thorac Surg,2009,88(3):733-739.
10.	Iung B,Rousseau-Paziaud J,Cormier B,et al. Contemporary results of mitral valve repair for infective endocarditis. J Am Coll Cardiol,2004,43(3):386-392.
11.	Zegdi R,Debièche M,Latrémouille C,et al. Long-term results of mitral valve repair in active endocarditis. Circulation,2005,111(19):2532-2536.
12.	Yamaguchi H,Eishi K,Yamachika S,et al. Mitral valve repair in patients with infective endocarditis. Circ J,2006,70(2):179-183.
13.	de Kerchove L,Vanoverschelde JL,Poncelet A,et al. Reconstructive surgery in active mitral valve endocarditis:feasibility,safety and durability. Eur J Cardiothorac Surg,2007,31(4):592-599.
14.	Omoto T,Tedoriya T,Oi M,et al. Significance of mitral valve repair for active-phase infective endocarditis. Asian Cardiovasc Thorac Ann,2011,19(2):149-153.
15.	Aragam JR,Weyman AE,chief Editor. Echocardiographic findings in infective endocarditis. In:Weyman AE,ed. Principles and Practice of Echocardiography. 2nd ed. Philadelphia:Lea & Fabiger,1994. 1178-1197.
16.	符竣,陶凉,陈绪发,等. 感染性心内膜炎外科治疗时机. 中国胸心血管外科临床杂志,2003,10(2):147-148.
17.	Podesser BK,Rödler S,Hahn R,et al. Mid-term follow up of mitral valve reconstruction due to active infective endocarditis. J Heart Valve Dis,2000,9(3):335-340.
18.	Eishi K,Kawazoe K,Kuriyama Y,et al. Surgical management of infective endocarditis associated with cerebral complications. J Thorac Cardiovasc Surg,1995,110(6):1745-1755.
19.	Omoto T,Ohno M,Fukuzumi M,et al. Mitral valve repair for infective endocarditis. Gen Thorac Cardiovasc Surg,2008,56(6):277-280.
20.	Ruttmann E,Legit C,Poelzl G,et al. Mitral valve repair provides improved outcome over replacement in active infective endocarditis. J Thorac Cardiovasc Surg,2005,130(3):765-771.
21.	Feringa HH,Bax JJ,Klein P,et al. Outcome after mitral valve repair for acute and healed infective endocarditis. Eur J Cardiothorac Surg,2006,29(3):367-373.
22.	Shang E,Forrest GN,Chizmar T,et al. Mitral valve infective endocar-ditis:benefit of early operation and aggressive use of repair. Ann Thorac Surg,2009,87(6):1728-1734.
23.	Jung SH,Je HG,Choo SJ,et al. Surgical results of active infective native mitral valve endocarditis:repair versus replacement. Eur J Cardiothorac Surg,2011,40(4):834-839.
24.	Musci M,Hübler M,Amiri A,et al. Repair for active infective atrioventricular valve endocarditis:23-year single center experience. Clin Res Cardiol,2011,100(11):993-1002.
25.	黄信生,谢进生,尤斌,等. 瓣膜成形术治疗原发性感染性心内膜炎二尖瓣关闭不全. 中华外科杂志,2009,47(16):1236-1238.
26.	高峰,孟旭. 二尖瓣成形术治疗感染性心内膜炎二尖瓣关闭不全. 中华胸心血管外科杂志,2011,27(6):357-360.

1. Evans CF,Gammie JS. Surgical management of mitral valve infective endocarditis. Semin Thorac Cardiovasc Surg,2011,23(3):232-240.
2. 张尔永,石应康,程述森,等. 原发性感染性心内膜炎瓣膜损害的外科治疗. 中国胸心血管外科临床杂志,1999,6(2):22-24.
3. 杨新伟,王志农,徐志云,等. 二尖瓣脱垂合并感染性心内膜炎的手术治疗. 第二军医大学学报,2009,30(2):133-136.
4. Moreillon P,Que YA. Infective endocarditis. Lancet,2004,363(9403):139-149.
5. López J,Revilla A,Vilacosta I,et al. Age-dependent profile of left-sided infective endocarditis:a 3-center experience. Circulation,2010,121(7):892-897.
6. Hasbun R,Vikram HR,Barakat LA,et al. Complicated left-sided native valve endocarditis in adults:risk classification for mortality. JAMA,2003,289(15):1933-1940.
7. Chambers HF. Transesophageal echocardiography in endocarditis. Chest,1994,105(2):333-334.
8. 朱晓东,张宝仁,主编.心脏外科学. 北京:人民卫生出版社,2007. 800-801.
9. Shimokawa T,Kasegawa H,Matsuyama S,et al. Long-Term outcome of mitral valve repair for infective endocarditis. Ann Thorac Surg,2009,88(3):733-739.
10. Iung B,Rousseau-Paziaud J,Cormier B,et al. Contemporary results of mitral valve repair for infective endocarditis. J Am Coll Cardiol,2004,43(3):386-392.
11. Zegdi R,Debièche M,Latrémouille C,et al. Long-term results of mitral valve repair in active endocarditis. Circulation,2005,111(19):2532-2536.
12. Yamaguchi H,Eishi K,Yamachika S,et al. Mitral valve repair in patients with infective endocarditis. Circ J,2006,70(2):179-183.
13. de Kerchove L,Vanoverschelde JL,Poncelet A,et al. Reconstructive surgery in active mitral valve endocarditis:feasibility,safety and durability. Eur J Cardiothorac Surg,2007,31(4):592-599.
14. Omoto T,Tedoriya T,Oi M,et al. Significance of mitral valve repair for active-phase infective endocarditis. Asian Cardiovasc Thorac Ann,2011,19(2):149-153.
15. Aragam JR,Weyman AE,chief Editor. Echocardiographic findings in infective endocarditis. In:Weyman AE,ed. Principles and Practice of Echocardiography. 2nd ed. Philadelphia:Lea & Fabiger,1994. 1178-1197.
16. 符竣,陶凉,陈绪发,等. 感染性心内膜炎外科治疗时机. 中国胸心血管外科临床杂志,2003,10(2):147-148.
17. Podesser BK,Rödler S,Hahn R,et al. Mid-term follow up of mitral valve reconstruction due to active infective endocarditis. J Heart Valve Dis,2000,9(3):335-340.
18. Eishi K,Kawazoe K,Kuriyama Y,et al. Surgical management of infective endocarditis associated with cerebral complications. J Thorac Cardiovasc Surg,1995,110(6):1745-1755.
19. Omoto T,Ohno M,Fukuzumi M,et al. Mitral valve repair for infective endocarditis. Gen Thorac Cardiovasc Surg,2008,56(6):277-280.
20. Ruttmann E,Legit C,Poelzl G,et al. Mitral valve repair provides improved outcome over replacement in active infective endocarditis. J Thorac Cardiovasc Surg,2005,130(3):765-771.
21. Feringa HH,Bax JJ,Klein P,et al. Outcome after mitral valve repair for acute and healed infective endocarditis. Eur J Cardiothorac Surg,2006,29(3):367-373.
22. Shang E,Forrest GN,Chizmar T,et al. Mitral valve infective endocar-ditis:benefit of early operation and aggressive use of repair. Ann Thorac Surg,2009,87(6):1728-1734.
23. Jung SH,Je HG,Choo SJ,et al. Surgical results of active infective native mitral valve endocarditis:repair versus replacement. Eur J Cardiothorac Surg,2011,40(4):834-839.
24. Musci M,Hübler M,Amiri A,et al. Repair for active infective atrioventricular valve endocarditis:23-year single center experience. Clin Res Cardiol,2011,100(11):993-1002.
25. 黄信生,谢进生,尤斌,等. 瓣膜成形术治疗原发性感染性心内膜炎二尖瓣关闭不全. 中华外科杂志,2009,47(16):1236-1238.
26. 高峰,孟旭. 二尖瓣成形术治疗感染性心内膜炎二尖瓣关闭不全. 中华胸心血管外科杂志,2011,27(6):357-360.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mitral Valvuloplasty for the Treatment of Infective Endocarditis and Mitral Regurgitation

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