Surgical Techniques for Four Valve Endocarditis Involving the Aorto-Mitral Fibrous Body: Hemi-Commando Procedure and Pulmonary Valve Homograft
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP063
Submission Type:
Abstract Submission
Authors:
Jorge Balzan (1), Nicolas Brozzi (2), Cedric Sheffield (2), Philip Bongiorno (2), Jose Navia (2), Federico Napoli (2), Otto Montero (2), Rene Aleman (2), Armando Nessim (2)
Institutions:
(1) Cleveland Clinic, Weston FL, Weston, Florida, (2) Cleveland Clinic, Weston, FL
Submitting Author:
Jorge Balzan
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Cleveland Clinic, Weston FL
Cleveland Clinic, Weston FL
Co-Author(s):
Nicolas Brozzi
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Cleveland Clinic
Cleveland Clinic
Cedric Sheffield
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Cleveland Clinic
Cleveland Clinic
Philip Bongiorno
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Cleveland Clinic
Cleveland Clinic
*Jose Navia
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Cleveland Clinic
Cleveland Clinic
Federico Napoli
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Cleveland Clinic
Cleveland Clinic
Otto Montero
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Cleveland Clinic
Cleveland Clinic
Rene Aleman
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Cleveland Clinic
Cleveland Clinic
Armando Nessim
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Cleveland Clinic
Cleveland Clinic
Presenting Author:
Jorge Balzan
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Abstract:
Surgical Techniques for Four Valve Endocarditis Involving the Aorto-Mitral Fibrous Body:Hemi-Commando Procedure and Pulmonary Valve Homograft
Objective
The endocarditis of 4 valves which involve the aorto-mitral fibrous body, is a condition that expresses severity of disease and for which surgical treatment implies a challenge and poor overall survival.(1) We report the first case successfully treated surgically by developing an hemmicomando procedure and pulmonary valve homograft.
Methods
A 32-year-old female with who was transferred. Currently being treated for infective endocarditis with Vancomycin and Gentamycin. Transthoracic echocardiography showed multiple large AV vegetations (5-25 mm), and mild AS. Blood cultures revealed Streptococcus Species. We performed open heart surgery (Figure 1), Aortic Valve Replacement # 26 Aortic Valve Homograft Hemi-Commando Procedure due to aortic valve endocarditis and aortic root abscess with invasion of the anterior leaflet of the mitral valve, Mitral Valve Repair #30 Annuloplasty Genesee Band, Membranous VSD Repair with Autologous Pericardial Patch, Pulmonary Valve Replacement with #26 Pulmonary Valve Homograft, Tricuspid Valve Repair #28 Annuloplasty MC3 Ring.
Results
As a result of the acute infection, the patient was in her immediate postoperative period with acute respiratory failure hypoxia requiring mechanical ventilation, acute renal failure with electrolyte imbalance. Helicobacter .pylori infection with melena episodes and congestive hepatopathy. Acute on chronic anemia, thrombocytopenia likely secondary to endocarditis and Septic shock. On day 20, a Tracheostomy was performed due to acute post-operative respiratory insufficiency. Postoperatively echocardiogram revealed LVEF 52+-5%, right ventricular systolic function is midly decreased, trace mitral valve regurgitation (Mean gradient 4mmHg), tricuspid valve annuloplasty ring (Mean gradient 2mmHg), homograft aortic valve (trace -+1, peak gradient 5mmHg, mean gradient 3mmHg), pulmonary homograft (peak gradient 16mmHg).
One month after the surgery, the patient is hemodynamically stable with a good recovery with intensive care unit stay, on rehabilitation and without signs of endocarditis or valve insufficiency and still on antibiotics Ertapenem for ESBL Klebsiella pneumoniae and Ceftriaxone for Strep mitis bacteriemia.
Conclusions
Physicians should be aware of this diagnosis which portends an exceedingly complex surgical technique.
Objective
The endocarditis of 4 valves which involve the aorto-mitral fibrous body, is a condition that expresses severity of disease and for which surgical treatment implies a challenge and poor overall survival.(1) We report the first case successfully treated surgically by developing an hemmicomando procedure and pulmonary valve homograft.
Methods
A 32-year-old female with who was transferred. Currently being treated for infective endocarditis with Vancomycin and Gentamycin. Transthoracic echocardiography showed multiple large AV vegetations (5-25 mm), and mild AS. Blood cultures revealed Streptococcus Species. We performed open heart surgery (Figure 1), Aortic Valve Replacement # 26 Aortic Valve Homograft Hemi-Commando Procedure due to aortic valve endocarditis and aortic root abscess with invasion of the anterior leaflet of the mitral valve, Mitral Valve Repair #30 Annuloplasty Genesee Band, Membranous VSD Repair with Autologous Pericardial Patch, Pulmonary Valve Replacement with #26 Pulmonary Valve Homograft, Tricuspid Valve Repair #28 Annuloplasty MC3 Ring.
Results
As a result of the acute infection, the patient was in her immediate postoperative period with acute respiratory failure hypoxia requiring mechanical ventilation, acute renal failure with electrolyte imbalance. Helicobacter .pylori infection with melena episodes and congestive hepatopathy. Acute on chronic anemia, thrombocytopenia likely secondary to endocarditis and Septic shock. On day 20, a Tracheostomy was performed due to acute post-operative respiratory insufficiency. Postoperatively echocardiogram revealed LVEF 52+-5%, right ventricular systolic function is midly decreased, trace mitral valve regurgitation (Mean gradient 4mmHg), tricuspid valve annuloplasty ring (Mean gradient 2mmHg), homograft aortic valve (trace -+1, peak gradient 5mmHg, mean gradient 3mmHg), pulmonary homograft (peak gradient 16mmHg).
One month after the surgery, the patient is hemodynamically stable with a good recovery with intensive care unit stay, on rehabilitation and without signs of endocarditis or valve insufficiency and still on antibiotics Ertapenem for ESBL Klebsiella pneumoniae and Ceftriaxone for Strep mitis bacteriemia.
Conclusions
Physicians should be aware of this diagnosis which portends an exceedingly complex surgical technique.
Mitral Conclave:
Challenging Clinical Cases
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