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KMID : 0368120020320110996
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Korean Circulation Journal
2002 Volume.32 No. 11 p.996 ~ p.1003
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Surgical Experience of Reconstruction of the Annular and the Intervalvular Fibrous Skeleton for Active Infective Endocarditis
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성기익/Ki Ick Sung
박표원/Pyo Won Park
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Abstract
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b>Background and Objectives: The treatment for active infective endocarditis（IE）with a paravalvular abscess results in a high morbidity and mortality. Recently, some good results with a reconstruction of the annulus or fibrous skeleton in active
IE have been published. However, there are few papers on this subject reported in Korea.
Subjects and Methods: The hospital records of 29 patients who had undergone surgery for active IE with a paravalvular abscess from Mar. 1995 to Jun. 2002 were retrospectively reviewed. The mean age was 43.8±16.9 （range：1369） years. The NYHA
functional class was either Ⅲ or Ⅳ in 11 cases（37.9%）and prosthetic valve endocarditis was present in 8 cases （27.6%）. The mean duration of preoperative antibiotic treatment was 13.3±11.9 days.
Results: The aortic annulus was reconstructed in 7 patients, an aortic annulus＋the aorto-mitral continuity was done in 8 cases, an aortic annulus＋mitral annulus＋aorto-mitral continuity was done in 1 case, and a mitral annulus was done in 13
cases. There was one （3.4%） early death due to a non-cardiac cause. The postoperative complications were as follows：additional surgery due to bleeding in 3 cases （10.3%）, mediastinitis in 1 case （3.4%）, a complete atrioventricular block in 1 case
（3.4%）, and a cerebral hemorrhage in 2 cases （6.9%） who had had a history of cerebral embolism. All patients （100%） were followed up with a mean follow-up duration of 22.0±19.2 months. There was 1 late death （3.6%） and 2 additional procedures
including one recurrence.
Conclusion: Reconstruction of the annulus and intervalvular fibrous skeleton in these patients showed a relatively low morbidity and mortality, and recurrence rate. Therefore, it is recommended that these patients be treated aggressively.
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KEYWORD
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Endocarditis, Abscess, Heart valves, Surgery,
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