MITRAL-VALVE RECONSTRUCTION DURING THE AC UTE-PHASE OF BACTERIAL-ENDOCARDITIS

Two patients in our institution underwent mitral valve reconstruction during the acute phase of Staphylococcus aureus mitral valve endocardi tis. In neither case was a pre-existing valve lesion found. Echocardio graphic examination revealed severe mitral insufficiency and the exten t of valvular lesions. In the first patient, prolapse of the posterior commissure and para-commissural areas was due to ruptured chordae ten dinae. In the second patient a perforated abscess was surrounded by ve getations in the median portion of the anterior leaflet and paramedian anterior chordae tendinae were ruptured. The surgical indication was hemodynamic, combined with suspicion of repeated emboli in one case. A fter a 10-day course of antibiotic therapy, both patients underwent su rgical repair by Carpentier's mitral valvuloplasty. During more than 6 months' follow-up no recurrence of endocarditis was observed. Both pa tients were in class I of the NYHA without echocardiographic evidence of residual mitral regurgitation or stenosis. Early intervention durin g the acute phase of endocarditis, when mitral valve destruction is no t too extensive, allows mitral valvuloplasty which preserves the nativ e valve, eradicates infected tissues and may reduce postoperative mort ality and morbidity.