Infective endocarditis and pregnancy

Infective endocarditis in pregnant women is a threatening disease that leads to significant maternal and perinatal losses. Methods for caring for such patients have not yet been standardized, and literature sources provide single descriptions of case reports. Objectives. To reduce maternal and perinatal mortality and disability, as well as to provide optimal management and delivery strategy for pregnant women with infective endocarditis. Materials and methods.This paper presents the experience of treating three cases of IE in pregnant women (n-2) and parturient (n-1) by specialists of a national multidisciplinary team. In all three cases, cardiology, cardiac surgery and perinatal tactics were personalized in accordance with the recommendations of the European Society of Cardiologists and the experience of the team members. Parturient with acute IE and septic clot of right ventricle underwent urgent cardiac surgery. Another pregnant was provided with conservative support by a multidisciplinary team due to the absence of indications for immediate surgery (she underwent aortic valve replacement and mitral valve repair in 11 days after in-term labour). The third one underwent cardiac surgery (mitral valve repair) with fetus in utero at 21 weeks of pregnancy after 11 weeks of de-escalation therapy by antibiotics. Results. In all cases, the immediate maternal and perinatal results were good. Follow-up for two cases we could observe (33 and 18 months after surgery) are good. Conclusions. Treatment tactic for pregnant women with acute IE that require heart surgery is always a compromise between the treatment and rehabilitation of a deep-preterm baby and the intra-operative risks to the fetus. Risk of intervention for mother and fetus can be minimized by a highly professional multidisciplinary team with wide experience in open-heart surgery, competent preparation of women for surgical treatment, conducting intraoperative fetal monitoring, as well as using special parameters of artificial circulation and anesthesia. Primary and secondary prevention of infectious complications in pregnant women at risk of IE is a powerful tool to reduce maternal, perinatal mortality and disability.

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Mitral Valve Repair in Rheumatic Disease: Early Results

Nepalese Heart Journal ◽

10.3126/njh.v3i3.26131 ◽

2004 ◽

Vol 3 (3) ◽

pp. 65

Author(s):

S Pradhan ◽

B Koirala ◽

R Koirala ◽

J Sharma ◽

A Acharya ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Heart Surgery ◽

Common Iliac Artery ◽

Open Heart Surgery ◽

Open Heart ◽

Valve Repair ◽

Left Common Iliac Artery ◽

Early Results ◽

Associated Lesions

Mitral valve repair is an accepted method of treating severe mitral valve disease due to rheumatic fever, Valve repair confers fewer complications and better survival as compared to mitral valve replacement. Since commencing open-heart surgery at SGNHC, 49 mitral valve repair operations have been performed here. There were 25 male and 24 female patients. The average age was 28.7 years (5 - 68 years). All were symptomatic with significant dyspnoea and palpitation. Other symptoms were hemoptysis in eight, peripheral embolism in one and CNS embolism in four. Associated lesions included ASD in three, an ASD and constrictive pericarditis in one and a pseudoaneurysm of the left common iliac artery with PDA in the fifth. One patient had undergone CMV nine years before presentation.

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A Concept for a Novel Procedure for Mitral Valve Repair by Percutaneous Annuloplasty

ASME 2008 3rd Frontiers in Biomedical Devices Conference ◽

10.1115/biomed2008-38085 ◽

2008 ◽

Cited By ~ 1

Author(s):

Toufic Azar ◽

Sumitra Rajagopalan ◽

Renzo Cecere ◽

Joszef Kovecses ◽

Jorge Angeles

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Heart Surgery ◽

Open Heart Surgery ◽

Mitral Valve Regurgitation ◽

The United States ◽

Valve Repair ◽

Operative Trauma ◽

Idiopathic Cardiomyopathy

Mitral valve regurgitation [1] (MVR) is a functional heart disease in which the valve does not close completely and causes blood to leak back into the left atrium. This condition increases the workload on the heart, and if left untreated, can lead to irreversible heart damage, cardiac arrhythmia, and congestive heart failure. Annually, in the United States, more than 50 000 patients undergo mitral valve repair. The causes of MR can be either primary, due to an anatomical change of the valve apparatus, or secondary to ischemic heart disease and idiopathic cardiomyopathy. Currently, the intervention requires an open heart surgery with cardiopulmonary bypass. Under such conditions, the patient is subjected to intra and post-operative trauma that can result in a mortality increase and that can prevent high risk individuals from undergoing the repair. A non-invasive percutaneous method would greatly reduce risks associated with a conventional surgery while increasing the potential candidates for repair. Introduced in this paper is a concept for a novel procedure that relies on a robotically-guided compliant catheter, fitted with an anchoring mechanism, intended to reshape the mitral-valve annulus to dimensions suitable for the effective support of the valve leaflets.

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Mitral valve repair: Infective endocarditis after MitralClip

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332630 ◽

2013 ◽

Vol 61 (S 01) ◽

Cited By ~ 2

Author(s):

D Maznikoski ◽

K Denk ◽

I Karliova ◽

CF Vahl

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

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Percutaneous Mitral Valve Repair in Patients with Prior Cardiac Surgery

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2012.01449.x ◽

2012 ◽

Vol 27 (3) ◽

pp. 295-298 ◽

Cited By ~ 6

Author(s):

Salvatore Scandura ◽

Gian Paolo Ussia ◽

Anna Caggegi ◽

Sarah Mangiafico ◽

Valeria Cammalleri ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair

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Mitral valve repair versus replacement for infective endocarditis, again

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.02.044 ◽

2019 ◽

Vol 158 (2) ◽

pp. e33-e34

Author(s):

Manuel J. Antunes

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

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Corrigendum to: Outcomes of mitral valve repair in acute native mitral valve infective endocarditis [Interact CardioVasc Thorac Surg 2019; doi:10.1093/icvts/ivz187]

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz228 ◽

2019 ◽

Vol 29 (5) ◽

pp. 820-820

Author(s):

Mohamed El Gabry ◽

Zaki Haidari ◽

Fanar Mourad ◽

Janine Nowak ◽

Konstantinos Tsagakis ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

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Active infective endocarditis after mitral valve repair

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-009-0479-0 ◽

2010 ◽

Vol 58 (1) ◽

pp. 49-52

Author(s):

Takashi Miura ◽

Kiyoyuki Eishi ◽

Koji Hashizume ◽

Shinichiro Taniguchi ◽

Kazuyoshi Tanigawa ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Active Infective Endocarditis

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Outcomes of mitral valve repair in acute native mitral valve infective endocarditis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz187 ◽

2019 ◽

Vol 29 (6) ◽

pp. 823-829 ◽

Cited By ~ 3

Author(s):

Mohamed El Gabry ◽

Zaki Haidari ◽

Fanar Mourad ◽

Janine Nowak ◽

Konstantinos Tsagakis ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Limited Resection ◽

Long Term Results ◽

Valve Repair ◽

Direct Closure ◽

Complex Procedure ◽

Hospital Stays

AbstractOBJECTIVESMitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis.METHODSBetween January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events.RESULTSThe mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively.CONCLUSIONSAlthough MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.

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Mitral valve repair for infective endocarditis: Kobe experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320947586 ◽

2020 ◽

Vol 28 (7) ◽

pp. 384-389

Author(s):

Yukikatsu Okada ◽

Takeo Nakai ◽

Takashi Muro ◽

Hisato Ito ◽

Yu Shomura

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Autologous Pericardium ◽

Ring Annuloplasty ◽

Group A ◽

Group B

Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

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