[A useful method for the surgical treatment of active infective endocarditis--a case report using the Teflon felt reinforcing method].
In the surgical treatment for active infective endocarditis (IE), perivalvular leakage is the most severe complication. We had a 42-year-old man who had active IE and a giant vegetation in the aortic valve, and a small mycotic aneurysm in the left ventricular outflow tract. Other operative observations included slight redness and a decrease in the reflex of the annular endocardium. We made a patch closure of the mycotic aneurysm, and aortic valve replacement using the Teflon felt reinforcing method. In the postoperative course, he had a pacemaker implantation with complete AV block. Postoperative pathological examination revealed inflammatory cells and plasma infiltration, and edematous change of the interstitial tissue around the cusp surface and annular side of the resected valve. These pathological changes could explain the redness and the decrease in the reflex of the annular endocardium. The edematous changes of the annular tissue might be the cause of postoperative perivalvular leakage. Reinforcement of the prosthetic valve with Teflon felt might be a useful method to prevent perivalvular leakage. There is, however, the possibility of acceleration or elongation of infective endocarditis. In our experiences of the surgical treatment for active IE, we performed valve replacement using Teflon felt in 6 patients, and not using in 27 patients. The mean period until CRP had been normalized was no significant difference between both groups (mean days using Teflon felt were 63.5 days, and not using were 75 days).(ABSTRACT TRUNCATED AT 250 WORDS)
Hirayama
T
T
Tokyo Women's Medical College, Department of Cardiovascular Surgery, Japan.
Hashimoto
A
A
Kawai
A
A
Nakano
K
K
Endo
M
M
Koyanagi
H
H
D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000601:surgery*; D004699:Endocardium / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D011138:Polytetrafluoroethylene
D011138:Polytetrafluoroethylene