title: Mitral valve repair and transesophageal echocardiographic findings in a high-risk subgroup of patients with active, acute infective endocarditis.
abstract: OBJECTIVE
  Limited data are available regarding the efficacy of mitral valve repair in patients affected by active, acute infective endocarditis. In addition, the predictivity of transesophageal echocardiography (TEE) for guiding the surgical decision-making process in these patients has not yet been reported. The study aim was to evaluate the long-term results of mitral valve repair and role of TEE in active, acute infective endocarditis.
  
  
  METHODS
  The study population consisted of patients affected by infective endocarditis of the mitral valve who underwent surgery. TEE was performed intraoperatively to guide the best surgical approach. All patients were followed up (mean 73+/-8 months) after surgery.
  
  
  RESULTS
  Twenty-eight patients underwent surgery for infective endocarditis; of these, 13 had mitral valve repair for active, acute infective endocarditis and formed the basis of the study. Sensitivity, specificity, positive predictive value, negative predictive value of TEE in detecting the mechanism of mitral regurgitation were 87%, 100%, 100% and 92%, respectively. The predictivity test of TEE in guiding surgical strategy was 94%. All patients were alive at the time of follow up; 10 (77%) were in NYHA class I and three in class II (23%). Mitral regurgitation was severe in one patient (8%), moderate in three (23%), mild in four (31%), and absent in five (38%). No relapses of active infective endocarditis were observed during the follow up period.
  
  
  CONCLUSIONS
  Mitral valve repair appears to be an effective treatment for active, acute infective endocarditis with mitral regurgitation and should be considered as a therapeutic strategy when surgery is contemplated. TEE has a fundamental role in the surgical decision-making process in these patients.
authors.affiliation: Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Senni
authors.forename: M
authors.initials: M
authors.lastname: Merlo
authors.forename: G
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: A
authors.initials: A
authors.lastname: Gamba
authors.forename: A
authors.initials: A
authors.lastname: Procopio
authors.forename: M
authors.initials: M
authors.lastname: Glauber
authors.forename: P
authors.initials: P
authors.lastname: Ferrazzi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000601:surgery; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D018570:Risk Assessment; D012422:Rupture, Spontaneous