Abstract
Introduction/aim: We are presenting the case of a patient suffering from fibrous cardiac skeleton damage caused by advanced infective endocarditis after aortic valve replacement surgery, whose cardiac surgery treatment proved to be successful. Case report: A redo procedure was performed through a median sternotomy using cardiopulmonary bypass. Artificial aortic and native mitral valves were excised and all infected tissue removed. Reconstruction of the fibrotic cardiac skeleton was done using two autologous pericardial patches according to Tyrone-David. Both mechanical valves were implanted. Conclusion: Successful treatment of one of the most difficult conditions in cardiac surgery can be achieved in our country.
Highlights
The fibrous cardiac skeleton is the central anatomic structure of the heart that supports the aortic, mitral and tricuspid valves. It can be damaged by infectious endocarditis, extensive calcification, or during mitral valve replacement surgery [1]
We are presenting the case of a patient with fibrous cardiac skeleton damage caused by advanced endocarditis after aortic valve replacement surgery, who has been successfully treated with cardiac surgery in our tertiary centre
Transoesophageal echocardiography (TEE) confirmed the findings of the transthoracic echocardiography (TTE), revealing a large abscess cavity just below the mechanical aortic valve that involved a large portion of the fibrous heart skeleton and had destroyed the anterior part of the mitral annulus (Figure 1)
Summary
The fibrous cardiac skeleton is the central anatomic structure of the heart that supports the aortic, mitral and tricuspid valves. Transoesophageal echocardiography (TEE) confirmed the findings of the TTE, revealing a large abscess cavity just below the mechanical aortic valve that involved a large portion of the fibrous heart skeleton and had destroyed the anterior part of the mitral annulus (Figure 1). The fibrotic cardiac skeleton was reconstructed, creating the base for mechanical valve implantation Both mechanical valves (aortic – St. Jude Medical Regent No 21 and mitral – OnX No 27/29) were implanted using single braided 2-0 sutures with pledgets. The aortic and mitral valves were excised.; b: reconstruction of the fibrous skeleton at the level of the anterior mitral cusp with a well-cut pericardial patch 1.; c: implantation of mitral prosthesis; posterior - on the preserved part of the mitral annulus, and anterior on the sutured patch. After several months of treatment, the patient was discharged and transferred to a regional rehabilitation centre
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