Successful posterıor mıtral leaflet reconstructıon wıth autologousperıcardıum ın a chıld wıth endocardıtıs

Abstract

We describe successful treatment, including valve repair for mitral endocarditis. A 9 year-old boy presented with weakness and high fever. Despite 2 weeks of antibiotics at the local hospital infectious signs persisted. To determine the cause of the fever, he was admitted to our hospital. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation; posterior leaflet was perforated and very large mobile vegetation was spread on the posterior wall of the left atrium. Abscess formation was visible beyond the posterior leaflet. Staphylococcus aureus was isolated from blood cultures. Intra-operatively, the patient underwent abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch. Mitral repair was achieved by quadrangular resection of the posterior mitral valve leaflet, retention of the primary and secondary chordae. Body of the posterior valve leaflet was reconstructed using fresh autologous pericardium. The constructed posterior valve was implanted on the edge of the sutured annular patch. Antibiotic therapy was continued for 6 weeks after surgery, and infections did not reoccur. The postoperative course was uneventfull and follow-up echocardiography showed minimally regurgitation of the mitral valve.