title: The Quattro valve and active infective endocarditis of the mitral valve.
abstract: OBJECTIVE
  Even today, infective endocarditis remains a therapeutic challenge. Active endocarditis at the time of valve implantation is an important risk factor for the development of prosthetic valve infection. This study reports results following implantation of the Quattro valve, a stentless chordally supported quadrileaflet mitral valve made from bovine pericardium.
  
  
  METHODS
  The Quattro valve was implanted in seven patients (four females, three males; mean age 34 years) requiring isolated mitral valve replacement for active bacterial endocarditis. All had congestive heart failure; two were in cardiogenic shock. The diagnosis of active endocarditis was based on clinical and echocardiographic findings, together with macroscopic evidence of acute infection at surgery, blood culture or histopathological evidence of valve infection. Postoperatively, all patients received at least four weeks of parenteral antibiotic therapy.
  
  
  RESULTS
  Congestive heart failure (and large pedunculated vegetations and mobile septic left atrial thrombi in two patients) prompted early surgical intervention. Patients underwent surgery at a mean of 7 days (range: 1-16 days) after admission. Endocarditis was caused by Gram-positive cocci in all patients except one. At a mean follow up of 15 months (range: 6-24 months) all patients were alive and symptomatically improved. To date, all remain free of prosthetic valve endocarditis, reoperation and thromboembolism.
  
  
  CONCLUSIONS
  The Quattro valve can be implanted safely in patients with acute bacterial endocarditis. The results also reflect the benefit of early surgical intervention in patients with infective endocarditis complicated by congestive heart failure, with or without large vegetations.
authors.affiliation: Divisions of Cardiology, Johannesburg Hospital, University of the Witwatersrand, South Africa.
authors.forename: S J
authors.initials: SJ
authors.lastname: Middlemost
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: M
authors.initials: M
authors.lastname: Sussman
authors.forename: P
authors.initials: P
authors.lastname: Manga
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001705:Bioprosthesis; D002417:Cattle; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents