Active infective endocarditis after mitral valve repair.
A 22-year-old man was diagnosed with active mitral endocarditis 14 months after mitral valve repair. The responsible organism was methicillin-resistant Staphylococcus epidermidis. Transthoracic echocardiography showed an 8-mm patch of vegetation adhering to the anterior part of the artificial ring. Although antibiotics (piperacillin, minocycline, imipenem/cilastatin, and ampicillin) were administered, the vegetation grew to 30 mm. Reoperation was performed 35 days after the diagnosis. Before surgery, there was mild mitral regurgitation without congestive heart failure. Re-repair was performed by removing the vegetation and the artificial ring, and mattress sutures repaired the circumferential sulcus formed by the artificial ring. Teicoplanin and minocycline were administered for 6 weeks. At 20 months, infective endocarditis was absent. Residual mitral regurgitation has been consistently mild. Although active mitral endocarditis after mitral valve repair is rare, prompt reoperation should be considered if the responsible organism is drug-resistant and infection spreads to the artificial ring.
Miura
Takashi
T
Department of Cardiovascular Surgery, Graduate School of Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. takashiren@yahoo.co.jp
Eishi
Kiyoyuki
K
Hashizume
Koji
K
Taniguchi
Shinichiro
S
Tanigawa
Kazuyoshi
K
Izumi
Kenta
K
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D020878:Device Removal; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000628:therapy; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008911:Minocycline / Q000627:therapeutic use*; D008945:Mitral Valve Prolapse / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000628:therapy; D012086:Reoperation; D013212:Staphylococcus epidermidis / Q000302:isolation & purification*; D017334:Teicoplanin / Q000627:therapeutic use; D055815:Young Adult
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D008911:Minocycline