Lesion removal and valvuloplasty of infective endocarditis

Infective endocarditis occurs in the aortic valve. Due to severe valve damage, the lesion is complex and the chance of valve formation is minimal. Endocarditis in the mitral or tricuspid region, after medical treatment for inflammation, the remaining valve damage can sometimes be corrected by angioplasty. In recent years, the literature reports that acute endocarditis is a surgical procedure for valve repair, and most cases can be cured. Treating diseases: infective endocarditis Indication Infective endocarditis with lesion clearance and valvuloplasty is applicable to: 1. The extent of invasion of endocarditis in the mitral valve area is generally lighter than that of the aortic valve. Often, only the leaflets are perforated or destroyed, sometimes causing chordae rupture. If the lesion is limited, most of the leaflets are intact, and the chordae are not affected. The lesions can be removed, and different orthoplasty can be performed according to the location and extent of the lesion. 2. In the tricuspid valve endocarditis, due to the low right ventricular pressure, the tricuspid inflammatory lesions are more limited, and the lesions are mostly confined to the valve leaflets. Therefore, valvuloplasty should be sought. Contraindications 1. Widely infected lesions, especially aortic valve lesions, leaflet damage is often more serious, accompanied by larger neoplasms, can not be angioplasty, valve replacement must be performed. 2. Endocarditis in the mitral valve area, except for the damage of the leaflets, combined with the majority of the chordae rupture at the edge of the anterior valve, can not be shaped surgery. Surgical procedure The mid-thoracic incision was used, moderate hypothermic cardiopulmonary bypass, and the corresponding cardiac cavity incision and different forming methods were used according to the location of the lesion. 1. Mitral valve leaflet local defect repair The defect formed by the inflammatory lesion of the anterior leaflet, regardless of the size of the area, requires tissue repair. Because the area of the anterior and posterior lobes are approximately equal, the rough area of the anterior lobes (ie, the contact surface of the leaflets) is less than that of the posterior lobes, and the defect is directly sutured, which tends to reduce the area of the leaflets and cause incomplete closure. In general, the autologous pericardial sheet is cut into a shape suitable for the defect, and the chordae at the edge of the anterior flap is retained, and then the suture is performed with a 4-0 non-invasive suture. Do not over-stretch when suturing, avoid tearing the delicate leaflet tissue, and avoid curling and wrinkling as much as possible, affecting the activity of the leaflets. The defect of the posterior leaflet can be removed by a rectangle, and a part of the annulus can be directly sutured and sutured, and generally does not cause stenosis or insufficiency. 2. Mitral anterior leaflet margin defect repair Patients with mitral valve prolapse are prone to endocarditis. These patients may be accompanied by chordae rupture in addition to valve leaf lesions. The repair method is to remove the diseased leaflets and the chordae attached to the fractured chordae, and the defect is formed by resection of the corresponding posterior lobes and the attached chordae, and the suture is sutured to the defect of the anterior leaflet for repair. The defect formed by the posterior flap is directly sutured, and the annulus of the defect is folded and sutured together. 3. Repair of adjacent leaflet defect at the posterior border of mitral valve The chordae of the posterior border of the mitral valve is longer than that of the former diplomatic community. Therefore, mitral valve prolapse is more likely to cause reflux in the posterior internal junction. On the basis of this endocarditis, when the adjacent valve leaflets are inflammatoryly damaged, the chordae tendine can also cause rupture. The repair method is: firstly, the diseased leaflets are removed, and then the anterior and posterior leaflets are respectively cut along the annulus at the junction, and the edge of the leaflet adjacent to the annulus is sutured to the annulus, and the boundary is reconstructed. The posterior flap is directly sutured with 2 or 3 needles to restore the opening and closing function of the valve. This method of repair is more complicated and must be carefully designed. First, do a few stitches to support the suture, observe the feasibility of repairing, and then do a precise intermittent suture. 4. Tricuspid valve defect repair Endocarditis in the right heart is less common than in the left heart. Tricuspid endocarditis is more likely to be invaded by the anterior tricuspid valve and its chordae because the anterior valve straddles the inflow tract of the right ventricle and the area of contact with the blood flow is larger than the other two leaflets. A small number of severely infected patients can form an annulus abscess or a myocardial abscess. If the infection only damages the leaflets or the chordae, you should seek valvuloplasty. There are three methods for forming: (1) Direct suture and annuloplasty after resection of the anterior valve lesion: When the inflammatory lesion invades the 1/2 of the anterior tricuspid valve and its chordae, it is resected along the lesion and is sewed with 5-0 polypropylene. The line is directly sutured to the diagonal margin, or the pericardial patch is applied. The folded annulus is made of 3-0 polypropylene suture with a self-pericardial spacer for intermittent or intermittent suture. (2) anterior posterior resection and two-valvuloplasty: after the removal of the posterior part of the tricuspid anterior flap, the remaining part of the anterior flap is sutured to the adjacent edge of the posterior flap, and the anterior and posterior flaps are closed. At the junction, the tricuspid valve becomes two-lobed, and the excess annulus at this point is intermittently sutured as described above. (3) patch plus chordae transfer anterior flap: inflammatory lesions in the middle of the tricuspid valve and chordae involved, left a large defect after resection, repair the defect with a semi-circular autologous pericardial patch, and the base of the anterior The chord is cut off, the papillary muscle connected to it is separated, and the cut chord is fixed on the edge of the pericardial patch to form a new anterior flap with traction function. Finally, add an annuloplasty to avoid leaving the incomplete closure.

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