Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body

David, Tirone E.; Kuo, J.F.; Armstrong, Susan

doi:10.1016/s0022-5223(97)70080-1

Cited by 151 publications

(135 citation statements)

References 10 publications

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“…Operations must be individualized because the pathology of aortic root abscess may vary. In particular, root abscess extending into the intervalvular fibrous body or into a prosthetic aortic and mitral valve is particularly difficult to treat, and in these cases, resection and reconstruction can be performed through the aortic root and dome of the left atrium 13,14…”

Section: Discussionmentioning

confidence: 99%

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

2014

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PurposeThis study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation.Materials and MethodsBetween February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50±14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed.ResultsThere were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8±11.8 mm to 52.6±8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4±12.0% to 49.8±16.5%, p<0.001). The mean follow-up duration was 68.7±40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2±0.7 to 1.2±0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%.ConclusionSurgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.

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Section: Discussionmentioning

confidence: 99%

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

2014

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“…Significant freedom from reoperation has been achieved with this technique. [11,12] A similar technique was employed in the present case during primary surgical repair. Two case series of DVR with lesions of MAIVF are reported.…”

Section: Discussionmentioning

confidence: 98%

Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

et al. 2014

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Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE) helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.

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“…It is also essential to emphasize that some MAIF pseudoaneurysms complicating MVR surgery may require a surgical approach through left atriotomy (three patients in group 2) in order to exclude the cavity from pulsating into the left atrium. In patients with severe multivalvular heart disease, special reinforcement with an oversewn patch and reconstruction of the intervalvular fibrous body during MVR and AVR [14,15] may be necessary. In the surgical scenario in which there is extensive calcification of the base of the heart, active infective endocarditis with abscess, or inadequate intervalvular fibrous tissue to secure a prosthetic valve because of previous interventions, the reconstruction of the MAIF may be crucial to prevent pseudoaneurysms.…”

Section: Operative Approachmentioning

confidence: 99%

“…In some cases, the mitral hingeline is incomplete in the anteromedial region of the orifice, where the interleaflet fibrous triangle between the left and the non-coronary aortic sinuses is located. The MAIF can be damaged by endocarditis, degenerative calcification or mitral and aortic valve surgery [3]. Damage caused by replacement of the aortic valve can lead to the formation of pseudoaneurysms (MAIF) or other complications [4,5].…”

Section: Introductionmentioning

confidence: 99%

Pseudoaneurysm of mitral-aortic intervalvular fibrosa

Grimaldi

Pozzoli

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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The mitral-aortic intervalvular fibrosa (MAIF) is involved in the functional integrity of the two valves. We discuss the clinical decision-making in a population with MAIF pseudoaneurysms following valve replacement surgery. From 2003 to 2010, 16 patients (age 65 ± 17 years) were referred to our institute with worsening valvular disease. All the patients had undergone previous aortic or mitral valve replacement surgery. Transthoracic and transesophageal echocardiography was performed in these patients. According to the echocardiographic findings, we described two groups of patients with MAIF pseudoaneurysms: group 1 (seven patients) without previously known infective disease, and group 2 (nine patients) with a medical history of endocarditis. For asymptomatic patients without an infective background or valve regurgitation (group 1), clinical and echocardiographic follow-up was selected. Reintervention was planned for postinfection pseudoaneurysms (group 2), on account of the residual paravalvular leak and the high-risk of MAIF rupture. The case series emphasizes the need for more awareness about MAIF pseudoaneurysms, rare complications of aortic and mitral valve surgery, which occur far more frequently than expected. Although clinical decision-making is debatable, it may be helpful to differentiate patients into those with or without previous endocarditis, and according to heart failure symptoms.

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Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body

Abstract: Reconstruction of the intervalvular fibrous body during aortic and mitral valve replacement is a satisfactory operative approach in patients with complex valve annular pathology.

Cited by 151 publications

References 10 publications

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

Pseudoaneurysm of mitral-aortic intervalvular fibrosa

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