Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction

Mitral valve infective endocarditis (IE) is the most common form of left-sided IE. A mitral annular abscess is present in 15% of cases of mitral valve IE. Annular abscesses are almost always located in the posterior mitral annulus. The presence of an annular abscess mandates careful debridement and reconstruction of the atrioventricular (AV) groove with a patch, prior to mitral valve replacement. We use a bovine pericardial patch to reconstruct the posterior annulus. The patch is fashioned to cover the defect by at least 1 – 2 cm circumferentially and is anchored with a running suture, starting at the deepest location in the ventricle and working in both directions toward the atrium. This suture line then extends across the AV groove and anchors the patch to the posterior left atrium. Close spacing of sutures, solid bites in the myocardium, and gentle tension on the suture assures a reliable and hemostatic repair.