Pulmonary valve neocuspidization and tricuspid valve replacement in intravenous drug abusers with infective endocarditis: Report of two cases

Abstract

Right-sided infective endocarditis accounts for 5–10% of endocarditis cases. It occurs predominantly among intravenous drug abusers. The pulmonary valve is involved in fewer than 2% of patients with endocarditis. Literature data are limited and optimal medical strategy, including surgical technique, remains non-standardized in this clinical situation. We present 2 patients treated surgically for tricuspid and pulmonary valve endocarditis and discuss a method of pulmonary valve neocuspidization based on the Ozaki technique.

Neocuspidization of the Pulmonary Valve with Autologous Pericardium in the Adult Patient with Ventricular Septal Defect and Infective Endocarditis: A Case Report and Review of the Literature

“…After the eradication of the bacterial agent, a surgical correction of CHD and IE may be performed on an elective basis. Expedited surgery should be reserved for cases with a poor response to optimal medical treatment, intractable hemodynamic compromise due to severe destruction of right-sided valves, large vegetations on PV, and septic embolization to the lungs [4,6]. The decision to perform surgical correction in our case was based on clinical, laboratory, and instrumental evidence of persistent infection and severe hemodynamic compromise despite optimal medical therapy.…”

“…This permits to use Ozaki concept for PV reconstruction. There are few reports on such experiences in the current literature [6,8,11]. All patients had normal anatomy of the PV annulus.…”

“…A unique feature of PVNeo is the flexibility of the technique. Only destroyed cusps of PV may be replaced, while intact leaflets are preserved [6,11]. GTAP, while used for aortic valve reconstruction, has demonstrated results comparable to those of biological prostheses in the mid-term follow-up [5].…”

“…Intraoperative transesophageal echocardiography (TEE) demonstrated excellent PVNeo valve geometry and function with a peak pressure gradient of 7 mm Hg across the valve and only trace insufficiency. A detailed description and video of the PVNeo technique have been presented in our previous report [6]. The postoperative period was uneventful.…”