Korean J Thorac Cardiovasc Surg.  2001 Jul;34(7):561-565.

Aortic and Mitral Valve Replacement with Reconstruction of the Intervalvular Fibrous Skeleton in Prosthetic Valve Endocarditis

  • 1Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Puchon-shi, Kyonggi-do, Korea.
  • 2Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, Inje University, College of Medicine, Korea.
  • 3Department of Thoracic and Cardiovascular Surgery, Gachon Medical College, Gil Heart Center, Korea.
  • 4Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
  • 5Department of Thoracic and Cardiovascular Surgery, KyungHee University Medical Center, Korea.


Patients who have complex endocarditis with involvement of both the aortic and mitral valves and intervalvular fibrous skeleton are among the most difficult to treat and still have the highest surgical mortality and morbidity rates. We report one case of aortic and mitral valve replacement with reconstruction of the fibrous skeleton performed in a 55-year-old female patient who had an aortic annular abscess and both the aortic and mitral prosthetic valve endocarditis with destruction of the fibrous skeleton. Previously, she had undergone redo double valve replacement. Transesophageal echocardiogram showed the paravalvular defect at the noncoronary aortic sinus and abnormal sinus tract along the fibrous skeleton. Emergent operation was performed due to positive blood cultures of staphylococcus epidermidis and persistent sepsis despite appropriate antibiotic therapy. After aortotomy extended to the roof of left atrium, both prosthetic valves and destroyed fibrous skeleton were completely resected and the aortic annular abscess was debrided and closed with a bovine pericardial patch. Reconstructions of both aortic and mitral annuli and the fibrous skeleton were done by using two separate bovine pericardial patches in triangular shape and mechanical valves were implanted. Postoperatively, adequate antibiotic therapies were continued and the patient was discharged at the postoperative 72 days without evidence of recurrence of endocarditis. Transthoracic echocardiogram of the postoperative 8 months shows no paravalvular leakage or recurrence of endocarditis and the patient has been followed up with no symptom.


Endocarditis; Prosthesis infection; Fibrous skeleton; Surgery method

MeSH Terms

Heart Atria
Middle Aged
Mitral Valve*
Sinus of Valsalva
Staphylococcus epidermidis
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