Early surgical correction of mitral valve infection endocarditis in 16-year old female patient

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Abstract

The optimal time for surgery on the heart valves in patients with active infectious endocarditis (IE) is still controversial. It is a well known fact that cerebral, coronary or renal thromboembolism is the most common cause of death in patients with left-sided IE. Thromboembolism can develop before the appearance of clinical manifestations of the destruction of the valvular apparatus of the heart. Currently, early surgical intervention is considered as the most effective method of treatment of many forms of active left-sided IE. Early surgery involves performing surgical correction until the completion of a full antibiotics course. We present the clinical case of early surgical correction of the patient (A., 16 years) with mitral valve infectious endocarditis. The disease was acute, with recurrent embolisms to the right kidney with infarction and to the left clavicle with osteomyelitis. Surgical intervention was performed as a matter of urgency; surgical access – right-sided anterolateral thoracotomy. The girl was operated on the 4th day of the hospitalization to our hospital. However, time of treatment was lost at the prehospital stage and rapid mitral valve destruction did not allow to repair the valve. Therefore, the mitral valve replacement was performed. The postoperative period was favorable. On the 3rd day after the operation, the girl was transferred to the cardiology department. On control ECHO after 3 years: myocardial contractile function is good, EF 65%, the function of the MV prosthesis is not impaired.

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About the authors

Ruslan B. Badurov

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: badurov.r@gmail.com

MD, PhD, Associate Professor, Department of Cardiovascular Surgery

Russian Federation, St. Petersburg

Nazim N. Shikhverdiev

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: nazniz@mail.ru

MD, PhD, Dr Med Sci, Professor, Department of Cardiovascular Surgery

Russian Federation, St. Petersburg

Tatyana L. Kornishina

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: tk.06@mail.ru

Assistant Professor, Department of Hospital Pediatrics

Russian Federation, St. Petersburg

Alina A. Ivanilova

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: iv.alina@bk.ru

4st year Student, Department of Cardiovascular Surgery

Russian Federation, St. Petersburg

Maria Yu. Novak

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: marylovepeace@mail.ru

Assistant Professor, Department of Cardiovascular Surgery

Russian Federation, St. Petersburg

References

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. CT scan of 16-year old female patient A. Changes in the head of the left clavicle

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3. Fig. 2. CT scan of 16-year old female patient A. Infarction of the right kidney

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4. Fig. 3. ECHO of 16-year old female patient A. The apical 4-chamber view. Vegetations on the aortic leaflet of mitral valve

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5. Fig. 4. ECHO of 16-year old female patient A. Parasternal long-axis view. Vegetations on the mural leaflet of the mitral valve

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6. Fig. 5. Transesophageal ECHO of 16-year old female patient A. Long axis. Arrows indicate vegetations on the mural leaflet of the mitral valve

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7. Fig. 6. Transesophageal ECHO of 16-year old female patient A. Short axis. Arrows indicate vegetations on the mural leaflet of the mitral valve

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8. Fig. 7. Intraoperative photo. Abscess on the mural leaflet of the mitral valve

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9. Fig. 8. Deleted mitral valve’s leaflets with vegetations.

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Copyright (c) 2020 Badurov R.B., Shikhverdiev N.N., Kornishina T.L., Ivanilova A.A., Novak M.Y.

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