Echocardiographic-Directed Decision-Making in Surgery for Mitral Valve Endocarditis

摘要

Infective endocarditis (IE) may cause significant destruction of the mitral valve. Surgical intervention in mitral valve IE may be valve repair or valve replacement, depending on the degree and location of the mitral valve damage. Perimitral involvement and destruction by IE complicates surgical decision-making with respect to valve repair versus replacement. The surgical management of mitral valve IE remains a challenge. Although clinical outcomes are significantly improved after mitral repair compared with mitral replacement, the optimal surgical procedure in a particular case is still debated.Echocardiography in mitral valve IE not only is pivotal in diagnosis but also in surgical decision-making. Transesophagealechocardiography (TEE) as compared with transthoracic echocardiography (TTE) is the modality of choice for precise diagnosis and mapping of anatomic abnormalities in mitral valve IE. The goal of preoperative echocardiography (frequently TTE) is typically to not only confirm diagnosis of mitral IE but also to confirm the indication for surgery. The focus of intraoperative echocardiography (frequently TEE) is not only confirmation of diagnosis and surgical indication in mitral IE. TEE must precisely delineate the septic process in and around the mitral valve with specific attention to the anatomic relations of the mitral valve and the complications of endocarditis. Intraoperative TEE is thus able to refine surgical decision-making with respect to mitral intervention. This case report of native mitral valve endocarditis highlights the pivotal role of intraoperative TEE in a case of complex mitral valve endocarditis, which is changing the surgical plan from mitral repair to complex mitral replacement, with excellent patient outcome.