MP34. Mitral Valve Repair and CRT-P Implant After Endocarditis in 16 Years Old Patient with Congenitally Corrected Great Arteries

New York Hilton Midtown 

Introduction:Valvular preservation will always be a challenge when it's done on patients with congenial cardiopathies. For adults cardiac surgeons, it's even harder to take the decision on how and when to treat these patients during their reinterventions. In this case, we would like to share our focus on CCTGA with right atrio-ventricular valve endocarditis as a consequence of an infected endocardial pacemaker.Case:A 16-year-old male patient with CCTGA and congenital atrioventricular blockage. Treated with an univentricular epicardial pacemaker implantation during his childhood and recently endocardial univentricular pacemaker implantation via endovascular approach. Facing complications with bacterial endocarditis (staphylococcus epidermidis) in the right atrio-ventricular valve consequence of pocket infection after the implantation.The patient received multiple cycles of parenteral antibiotics without evidence of clinical improvement. On his echocardiographic control there's evidence of the presence of multiple vegetations with emboligenic potential in the non-systemic valve (figure1). Surgical exploration is decided and in the same operative act the placement of a resynchronizer (CRT-P).Procedure:Firstly, it was decided to remove the pacemaker electrode in the hemodynamics room and later go into surgery to perform a resternotomy, starting with the ECC with peripheral vascular access.Atrioventricular and aortopulmonary double discordance was found. Severe insufficient mitral valve (figure 2) with destructuring of the posterior leaflet with multiple vegetations (figure 3). Initially, resynchronizer electrodes were placed in both ventricles. Afterwards, the reparation of the mitral valve was made (Removal of the infected quadrant together with its subvalvular apparatus). The reconstruction was completed Closure of the defect in the posterior leaflet with and placement of artificial cords in its free edge with PTFE.The control during his 3-year follow-up of his control echocardiogram showed improvement of his function(figure 4).Summary:Pacemaker infection and endocarditis can be an undesirable complication. Management of such complication deserve early and specialized treatment.In this particularly case with CCTGA and atrioventricular block requiring open heart surgery for mitral valve repair due to infective endocarditis and implant de CRT-P seems to be a better choice than standard AV dual pacing in order to avoid failure in long term (figure 5).