Surgical treatment of mitral valve paravalvular abscess in a patient undergoing chronic haemodialysis
Introduction: Infective endocarditis is more common in patients on chronic haemodyalisis than in the general population and constitutes the second most common cause of death in this group. Mitral valve paravalvular abscess is a serious complication of infective endocarditis which predicts future complications. Case report: A 53-year-old female patient was admitted in our institution for surgical treatment of mitral insufficiency and coexisting formation in the left atrium with a great risk of embolization. The patient had been treated by haemodialysis for end-stage renal disease due to diabetic nephropathy. TEE revealed a callosity located near the posterior mitral cusp, with a cavity in its centre. Surgical exploration revealed the existence of an abscess cavity filled with purulent content, encapsulated, restrained from the surrounding tissue in the posterior part of the mitral anulus. Aggressive debridement of the abscess cavity and involved tissue was performed. After that, a mitral biological prosthesis was implanted. Enterobacter spp. was isolated from the operative specimens. Annular defect after debridement can be reconstructed by a pericardial patch (fresh autologous pericardium, glutaraldehyde fixed pericardium or Dacron fabric) or the tissue of the left atrial appendage. Conclusion: The presence of a paravalvular abscess as a complication of IE significantly increases the complexity of surgical treatment and leads to increased mortality. The basic principle of surgical treatment of mitral valve paravalvular abscess is aggressive debridement and resection of the infected tissue.
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