Hosseini Saeid, Rezaei Yousef, Mazaheri Tina, Almasi Noushin, Babaei Touraj, Mestres Carlos A
Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Infectious Diseases, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Heart Valve Dis. 2016 Nov;25(6):730-738.
Background and aim of the study: Tricuspid valve (TV) infective endocarditis (TVIE) is uncommon and is mainly cured with medical treatment. When surgery is indicated, the appropriate surgical option remains to be determined. The study aim was to determine whether valve reconstruction using autologous pericardium is a safe and efficacious procedure to treat TVIE. Methods: A retrospective review was conducted of patients who underwent surgery for acute isolated TVIE with periannular involvement. Radical debridement was performed to provide a safe ground for pericardium implantation. Untreated pericardial patches were prepared and sutured to the remaining part of the debrided annulus. Neochordae were fashioned with polytetrafluoroethylene sutures attached to the free edge of the pericardial neoleaflet. Results: A total of 448 patients underwent TV surgery between September 2007 and May 2013 at the authors’ center. Nine patients (six males, three females; mean age 28 ± 4.9 years) underwent TV repair with pericardium for isolated TVIE. All male patients were intravenous drug users, and the three female patients had infected central venous catheters. Microbiology confirmed growth of Staphylococcus aureus alone in three cases, S. aureus and Candida sp. in two cases, methicillin-resistant S. aureus in one case, and Pseudomonas aeruginosa in one case. The culture was negative in two cases. There was no inhospital mortality, and the mean follow up was 16.4 ± 14.1 months. The latest follow up echocardiography revealed moderate tricuspid regurgitation in nine patients. Two non-cardiac-related deaths occurred, but there were no cases of recurrent endocarditis or reoperation. Conclusion: Valve reconstruction utilizing autologous pericardium and neochordae could be used with acceptable results in isolated TVIE cases with periannular involvement.
三尖瓣感染性心内膜炎（TVIE）较为罕见，主要通过药物治疗。当需要进行手术时，合适的手术方式仍有待确定。本研究的目的是确定使用自体心包进行瓣膜重建治疗TVIE是否是一种安全有效的方法。方法：对因急性孤立性TVIE伴瓣周受累而接受手术的患者进行回顾性分析。进行根治性清创以提供心包植入的安全基础。准备未处理的心包补片并缝合至清创后瓣环的剩余部分。用附着于心包新叶游离缘的聚四氟乙烯缝线制作新腱索。结果：2007年9月至2013年5月期间，作者所在中心共有448例患者接受了三尖瓣手术。9例患者（6例男性，3例女性；平均年龄28±4.9岁）因孤立性TVIE接受了心包三尖瓣修复术。所有男性患者均为静脉吸毒者，3例女性患者有感染的中心静脉导管。微生物学检查证实，3例仅为金黄色葡萄球菌生长，2例为金黄色葡萄球菌和念珠菌属生长，1例为耐甲氧西林金黄色葡萄球菌生长，1例为铜绿假单胞菌生长。2例培养结果为阴性。无住院死亡病例，平均随访时间为16.4±14.1个月。最新的随访超声心动图显示这些患者中有9例存在中度三尖瓣反流。发生了2例与心脏无关的死亡，但无复发性心内膜炎或再次手术病例。结论：对于伴有瓣周受累的孤立性TVIE病例，利用自体心包和新腱索进行瓣膜重建可取得可接受的效果。
