Reconstruction of the mitral anulus.

The mitral anulus was reconstructed with autologous pericardium in nine patients. Six patients had infective endocarditis with one or more abscesses in the anulus, and three had an iatrogenically damaged anulus. In patients with disruption of the mitral anulus limited to its posterior portion, a semicircular patch of pericardium was sutured directly to the endocardium of the left ventricle. In patients with multiple defects in the anulus, circumferential reconstruction of the mitral ring with pericardium was performed. In cases in which abscesses involved the central fibrous body, pericardium was used to reconstruct both the mitral anulus and the aortic root. Eight patients survived and have remained well for a mean of 8 months. There has been no prosthetic or patch dehiscence. All patients experienced substantial functional improvement. This experience indicates that the disrupted mitral anulus can be successfully reconstructed with autologous pericardium that is sutured directly to the endocardium of the left ventricle.