Surgical treatment of mitral valve paravalvular abscess in a patient undergoing chronic haemodialysis

  • Ivica Safradin
  • Ante Lekic
  • Stjepan Ivankovic
  • Bojan Biocina
Keywords: paravalvular abscess, mitral insufficiency, 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.


Download data is not yet available.


Nucifora G, Badano LP, Viale P, Gianfagna P, Allocca G, Montanaro D, Livi U, Fioretti PM. Infective endocarditis in chronic haemodialysis patients: an increasing clinical challenge. Eur Heart J. 2007; 28(19):2307-12.

Kamalakannan D, Pai RM, Johnson LB, Gardin JM, Saravolatz LD. Epidemiology and clinical outcomes of infective endocarditis in hemodialysis patients. Ann Thorac Surg. 2007;83(6):2081-6.

David TE, Regesta T, Gavra G, Armstrong S, Maganti MD. Surgical treatment of paravalvular abscess: longterm results. Eur J Cardiothorac Surg. 2007 Jan;31(1):43-8.

Kang N, Wan S, Ng CS, Underwood MJ. Periannular extension of infective endocarditis. Ann Thorac Cardiovasc Surg. 2009;15(2):74-81.

Yamaguchi H, Eishi K. Surgical treatment of active infective mitral valve endocarditis. Ann Thorac Cardiovasc Surg. 2007;13(3):150-5.

Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC. Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Am Heart J. 2007;154(5):923-8.

Spies C, Madison JR, Schatz IJ. Infective endocarditis in patients with end-stage renal disease: clinical presentation and outcome. Arch Intern Med. 2004;164(1):71-75.

Arora H, Madan P, Simpson L, Stainback RF. Caseous calcification of the mitral annulus. Tex Heart Inst J. 2008;35(2):211-3.

How to Cite
Safradin I, Lekic A, Ivankovic S, Biocina B. Surgical treatment of mitral valve paravalvular abscess in a patient undergoing chronic haemodialysis. Acta Chir. Croat. [Internet]. 2011Dec.1 [cited 2021Dec.7];8(1):31-5. Available from:
Case Reports

Most read articles by the same author(s)