Reparative approach for right-sided endocarditis. Operative considerations and results of valvuloplasty.

From 1981 to 1986, 12 patients were operated on for right-sided endocarditis after the failure of initial medical treatment (five staphylococcal, three streptococcal, two fungal, one gram-negative, and one mixed organism). The sources of infection were intravenous drugs in six patients, central catheters in two, and malformations in four. Preoperatively, 10 of 12 (83%) of these patients were in class III or IV. Reparative or reconstructive approaches, including valvuloplasty, were attempted for all these right-sided endocarditis lesions and were hemodynamically effective in 10 of 12 (83%) patients. The low right-sided intracardiac pressures and the three-leaflet configuration (one pulmonary and nine tricuspid valves) have lent themselves to this approach. Extensive annular invasion and multileaflet infections were technical limitations in the remaining patients. The overall outcome was favorable during the mean follow-up period of 25 months (hospital mortality 1/12, 8.3%; late death 1/11, 9%). Reparative or reconstructive approaches for right-sided infective endocarditis should be considered and can be successfully achieved. Their advantages include (1) improved hemodynamics, (2) low recurrence, and (3) favorable long-term results without staged or simultaneous prosthetic valve replacement.