ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2007;84:1943-1948. doi:10.1016/j.athoracsur.2007.04.116
© 2007 The Society of Thoracic Surgeons
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Martin Czerny
Ernst Wolner
Rainald Seitelberger
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gottardi, R.
Right arrow Articles by Seitelberger, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gottardi, R.
Right arrow Articles by Seitelberger, R.
Related Collections
Right arrow Valve disease
Right arrowRelated Article

Original Articles: Cardiovascular

Midterm Follow-Up of Tricuspid Valve Reconstruction Due to Active Infective Endocarditis

Roman Gottardi, MDa, Jan Bialy, MDa, Elena Devyatko, MDb, Heinz Tschernich, MDc, Martin Czerny, MDa, Ernst Wolner, MDa, Rainald Seitelberger, MDa,*

a Department of Cardiothoracic Surgery, Medical University Vienna, Vienna, Austria
b Department of General Surgery, Medical University Vienna, Vienna, Austria
c Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria

Accepted for publication April 27, 2007.

* Address correspondence to Dr Seitelberger, Department of Cardiothoracic Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria (Email: rainald.seitelberger{at}meduniwien.ac.at).


   Abstract
Top
 Abstract
Introduction
 Material and Methods
 Results
 Comment
 References
 
Background: Surgical methods for treatment of tricuspid valve (TV) endocarditis include complete TV excision, TV replacement, and the use of various reconstructive techniques even in cases of severe TV destruction and incompetence. This study summarizes our experience with TV reconstruction and replacement in patients with severe TV endocarditis.

Methods: Between October 1997 and July 2004, TV reconstruction was performed in 18 patients (mean age, 38 ± 17 years; 7 women, 11 men), and TV replacement in 4 patients (mean age, 48 ± 22 years; 2 women, 2 men). All patients presented with active endocarditis and severe TV incompetence. Reconstructive techniques included debridement of vegetations, complete resection of infected or destroyed leaflet tissue, leaflet reconstruction with pericardial tissue, sliding plasty of residual valve tissue and bicuspid valve formation with construction of a new commissure, and consecutive ring annuloplasty in all patients.

Results: There were no perioperative deaths. Late mortality was 0% for patients with TV reconstruction and 25% (n = 1) in the TV replacement group. At the latest follow-up (78% complete; mean, 53 ± 18 months), 11 patients had no recurrent TV incompetence. Three patients presented with TV incompetence grade I or II. Two patients with TV reconstruction had recurrent TV endocarditis between 3 and 18 month postoperatively, including new vegetations in both patients and an additional pleural empyema in one. In all cases, conservative treatment was successful and no reoperation was required.

Conclusions: The results of our study clearly demonstrate that in patients with severe TV endocarditis, complex reconstructive techniques yield excellent midterm results with regard to freedom of recurrence of endocarditis and valvular competence and should be considered as the primary surgical option in these patients. Tricuspid valve replacement should only be performed in cases of severe TV destruction that renders reconstructive techniques impossible.


   Introduction
Top
 Abstract
 Introduction
Material and Methods
 Results
 Comment
 References
 
Tricuspid valve endocarditis is a rare clinical entity, accounting for only 14% of patients with infective endocarditis [1, 2]. Reports on tricuspid endocarditis are increasing during the last two decades because of the growing number of patients addicted to intravenous drug abuse and patients with antiarrhythmic devices such as pacemakers and implantable defibrillators or long-term intravenous catheters [3, 4]. In contrast to left-sided endocarditis, right-sided endocarditis usually involves previously normal valves. Uncomplicated right-sided and left-sided endocarditis is successfully treated medically in 80% of patients; however, in the remaining 20%, conservative treatment is not effective and surgical treatment is required [5, 6]. Treatment options range from total valve excision without consecutive valve replacement to valve replacement and reconstruction. All procedures are controversial with regard to hemodynamic consequences and long-term prognosis. Valve excision without replacement results in massive tricuspid regurgitation and ventricularization of right atrial pressures as a result of a larger V wave and requires reoperation in more than 20% of patients because of right heart failure resulting from the massive regurgitation [7, 8]. Valve replacement with either a biologic or a mechanical valve exposes the patient to valve-related complications and the risk of recurrent endocarditis, especially in patients addicted to intravenous drugs and, in mechanical valves, also precludes the possibility of endocardial pacing.

On the other hand, several reports on tricuspid reconstruction demonstrate that this treatment option offers good results with respect to hemodynamics and long-time survival. A number of different reconstructive techniques have been described, including debridement of vegetations, complete resection of infected or destroyed leaflet tissue, leaflet reconstruction with pericardial tissue, sliding plasty of residual valve tissue, bicuspid valve formation with construction of a new commissure, and ring annuloplasty [9,10]. In this study, we report our experience in patients with tricuspid endocarditis and the extensive use of various reconstructive techniques combined with the implantation of a tricuspid annuloplasty ring.


   Material and Methods
Top
 Abstract
 Introduction
 Material and Methods
Results
 Comment
 References
 
Between October 1997 and July 2004, 22 consecutive patients with active tricuspid valve endocarditis underwent surgical treatment at our institution. In 1997 we started to aggressively use reconstructive techniques rather than valve replacement in all patients presenting with active infective tricuspid valve endocarditis. The aim of this retrospective study was to analyze our results after tricuspid valve reconstruction for active infective tricuspid endocarditis during at least a midterm follow-up period. The ethics committee approved the study and waived the need for patient consent.

Patient Characteristics
In 17 patients tricuspid valve endocarditis was isolated. Two patients were diagnosed with additional endocarditis of the aortic valve, and 1 patient had additional endocarditis of the aortic and mitral valves. In 1 of the patients with aortic valve endocarditis, a ventricular septal defect was also present. Two patients had concomitant significant mitral valve insufficiency not related to endocarditis. Three patients had prior cardiac surgery. One patient had prior aortic valve replacement, 1 patient had mitral valve replacement, and 1 patient had mitral valve replacement and DeVega annuloplasty of the tricuspid valve.

Before the operation all patients exhibited signs of acute infection, such as high fever and leukocytosis. Five patients presented with septic pulmonary emboli. Causes of tricuspid endocarditis were intravenous drug abuse in 12 patients, infected pacemaker leads in 5 patients, and congenital lesion (ventricular septal defect) in 1 patient. Factors predisposing to endocardial infections were present in the 3 patients who underwent prior cardiac surgery and valve replacement. In 1 patient no apparent cause for endocarditis could be detected. Blood cultures revealed Staphylococcus aureus (n = 10), Staphylococcus epidermidis (n = 2), Enterococcus faecalis (n = 1), Streptococcus bovis (n = 1), and Streptococcus milleri group (n = 1). In 7 patients no bacterial growth was detected, which was most likely because of previous antibiotic therapy. In the drug addict group, 6 patients were HIV positive and 9 patients were hepatitis C positive. Preoperatively, 11 patients were in New York Heart Association (NYHA) functional class II, 8 patients were in NYHA class III, and 3 patients were in NYHA class IV. In all patients, preoperative transthoracic echocardiography was performed, and the diagnosis of tricuspid valve endocarditis was established according to the Duke endocarditis service criteria [11]. All patients had significant tricuspid valvular incompetence with grade II in 2 patients, grade III in 15 patients, and grade IV in 5 patients. Infection with HIV did not influence our decision-making process, as several authors could demonstrate that mortality rates are equal compared with HIV-negative patients as long as CD4 counts are greater than 200/mm3 [12, 13].

Indication for Surgery
In our series the indication for surgery was largely based on the echocardiographic findings such as significant tricuspid valve insufficiency (grade III or IV) or vegetation size (larger than 1.5 cm) as well as vegetation morphologic features with additional hemodynamic compromise. If the clinical situation allowed, we tried to postpone surgery until the infection decreased.

Surgical Methods
In all patients tricuspid valve reconstruction was attempted and was successfully achieved in 18 patients (mean age, 38 ± 17 years; female/male, 7/11). In 4 patients (mean age, 48 ± 22 years; female/male, 2/2) reconstruction was not possible because of extensive valvular destruction. Those patients underwent tricuspid valve replacement. Three patients received a biologic valve, and 1 patient received a mechanical valve.

Reconstructive Techniques
Several reconstructive techniques were used depending on the site and extent of endocarditic lesions. In most of the patients with infected pacemaker leads (n = 4), the endocarditic lesion was limited to the posterior leaflet. In those patients, bicuspid valve formation of the tricuspid valve was performed as follows: the posterior leaflet was completely excised, the anterior and septal leaflets were partially mobilized, plication sutures were put in place, and a sliding plasty of the remaining two leaflets was performed (Fig 1).


Figure 1
View larger version (41K):
[in this window]
[in a new window]

  		Fig 1. (A) Endocarditic lesion on the posterior leaflet. (B) Excision of the posterior leaflet. (C) Partial mobilization of the anterior and septal leaflet and preparation of plication sutures. (D) Bicuspid leaflet formation of the valve. (E) Stabilization of the valve with a tricuspid annuloplasty ring.

 
In case of leaflet perforation or endocarditic vegetations within the leaflet, the respective lesion was excised and a patch plasty was performed, using an autologous pericardial patch. This technique was used in case of defects or vegetations involving either the anterior leaflet (n = 2), the septal leaflet (n = 3), or even both leaflets (n = 2; Fig 2).


Figure 2
View larger version (51K):
[in this window]
[in a new window]

  		Fig 2. Endocarditic lesion on the anterior leaflet (A), the posterior leaflet (B), or on both (C), anterior and septal leaflet (D–F) situs after excision of the endocarditic lesion, patch plasty, and stabilization of the valve with a tricuspid annuloplasty ring.

 
In cases of limited leaflet destruction but involvement of the subvalvular apparatus (n = 3), the infected or destroyed leaflet tissue including the involved chordae was completely resected. The defect was closed by performing a quadrangular excision of healthy leaflet tissue of the opposing leaflet including the attached chordae and transposition to the primary defect. Depending on the size of the excised healthy leaflet tissue, the resulting defect was closed by readapting the leaflet with or without a concomitant sliding plasty (Fig 3).


Figure 3
View larger version (45K):
[in this window]
[in a new window]

  		Fig 3. (A) Limited endocarditic lesion on the septal leaflet involving the subvalvular apparatus. (B) Resection of the infected or destroyed leaflet tissue and quadrangular excision of healthy leaflet tissue of the opposing leaflet. (C) Transposition of the leaflet. (D) Tailoring of the transposed leaflet tissue. (E) Sewing in of the transposed leaflet tissue and closure of the defect on the opposing leaflet. (F) Stabilization of the valve with a tricuspid annuloplasty ring.

 
In 2 patients the endocarditic lesion was limited to one commissure. In those patients, the infected tissue was excised and a sliding plasty of the adjacent leaflets was performed similar to the technique described for bicuspid valve formation.

In 2 patients, more than one of the described techniques were combined. In all patients, a prosthetic annuloplasty ring was implanted to stabilize the valve geometry and to prevent future ring dilatation. In this series the original Carpentier-Edwards tricuspid annuloplasty ring and, more recently, the Edwards Lifescience MC3 annuloplasty system were used. The predominant size of rings implanted was 30 mm.

Antibiotic Treatment
All patients received parenteral and oral antibiotics for at least 6 weeks postoperatively. Specific antibiotics were given in those patients who had positive blood or valve cultures, and broad-spectrum empirical therapy was performed in all other cases.

Follow-Up
Follow-up included transthoracic echocardiography and evaluation of functional recovery according to NYHA classification and was performed at 6 months after surgery and then every other year.


   Results
Top
 Abstract
 Introduction
 Material and Methods
 Results
Comment
 References
 
There was no intraoperative death. Mean follow-up was 53 ± 18 months and was 81% complete (n = 17). The remaining 4 patients (3 patients in the reconstruction group and 1 patient in the replacement group) were not available for follow-up. However, in 3 of those patients recent discharge reports from other hospitals because of admissions for other medical reasons were obtained that did not indicate any recurrence of endocarditis or other cardiac problems, and none of these patients was quoted in the Austrian Death Registry. One patient died 2 months after tricuspid valve replacement as a result of cardiopulmonary failure. In this patient, a De Vega anuloplasty and mitral valve replacement had been performed 15 years earlier. He presented with acute tricuspid valve endocarditis but had already suffered from the consequences of chronic tricuspid regurgitation for several years. He was operated on under the clinical picture of acute endocarditis and severe chronic right heart failure and eventually died of sustained and therapy-resistant right heart failure. In the postmortem examination no sign of recurring endocarditis of the newly implanted tricuspid valve was detected.

Two patients with tricuspid valve reconstruction had recurring tricuspid valve endocarditis between 3 and 18 month postoperatively, including new vegetations in one and pleural empyema in the other. In both cases, conservative treatment was successful and no reoperation was required. At the latest follow-up transthoracic echocardiography showed no recurrent tricuspid incompetence in 11 patients and tricuspid valve incompetence grade I to II in 4 patients. Postoperatively NYHA classification improved in all patients from preoperative NYHA 2.6 ± 0.7 to NYHA 1.4 ± 0.5. Seven of the 12 patients who were preoperatively intravenous drug abusers discontinued this habit and were enrolled in a drug-substitution program. In patients with infected pacemaker leads new leads were implanted 2 to 3 weeks after the initial surgery.


   Comment
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
References
 
The incidence of tricuspid valve endocarditis has risen during the last three decades [14, 15] for several reasons: (1) The number of people addicted to intravenous drug abuse that predisposes to tricuspid valve endocarditis is growing [16]. (2) Advances in interventional electrophysiology have prolonged the survival of patients with heart block or malignant tachyarrhythmia, and there is a concomitant use of implantable devices as pacemakers and defibrillators [17, 18]. (3) There is an increase in patients who are treated with long-term central venous catheters [19].

Fortunately, most cases (approximately 80%) [6, 20] of uncomplicated right-sided endocarditis can be treated successfully with antibiotics. Endocarditis is termed uncomplicated in the absence of intracardial or extracardial complications, hemodynamic compromise, or infection with a highly virulent microorganism [21]. The abnormal cardiovascular hemodynamics associated with isolated tricuspid or pulmonary valve endocarditis often allows time for medical treatment because of the greater tolerance for tricuspid valve regurgitation and pulmonary embolization [22].

Successful surgical treatment of acute infective endocarditis should include radical debridement of infected tissue [23] and restoration of physiologic valve function, and several very diverse surgical approaches have been published [9, 10]. Valvulectomy without simultaneous replacement as proposed by Arbulu and associates [4, 7, 8] is the most aggressive treatment and was especially promulgated in intravenous drug abusers owing to the radical debridement and the avoidance of any prosthetic material, which is of special importance in patients with ongoing intravenous drug abuse. However, 20% of these patients do not tolerate this massive tricuspid regurgitation despite intensive medical treatment and need a second operation for implantation of a prosthetic valve as a result of progressive right heart failure [3, 8].

Valve replacement is another treatment option, and the development of bileaflet mechanical valves and biologic valves has greatly improved the prognosis of patients after tricuspid valve replacement [24]. Mechanical valves in the tricuspid position are at a significantly higher risk for thrombosis compared with valves in the aortic or mitral position [25] and, consequently, are at higher risk for early reoperation [26]. However, in long-term follow-up mechanical valves are favorable over biologic valves as a result of valvular degradation in biologic valves [27], and therefore mechanical valves should be chosen in younger patients with good long-term prognosis. Nevertheless, patients addicted to intravenous drug abuse and patients with transvenous pacemaker leads are at higher risk to become reinfected, and compliance to long-term anticoagulation is unpredictable.

During the past decades tricuspid valve reconstruction has become a more frequently used treatment alternative in active infective tricuspid valve endocarditis with a number of different treatment modalities such as Kay plasty [28], partial replacement of the tricuspid valve by mitral homografts [29], commissuroplasty, sliding plasty, the use of pericardial patches [9], the use of artificial chordae [10], and reconstruction of the tricuspid valve annulus with an autologous pericardial patch [30]. In some of these series [17, 31], tricuspid valve reconstruction was performed without the use of any foreign material to avoid recurring endocarditis even if significant residual tricuspid valve insufficiency was present. Both the latter studies agreed that the use of a prosthetic annuloplasty ring might have led to a better functional result in some of their patients. However, we think that the avoidance of prosthetic material should not compromise radical eradication of all infected tissue, long-term freedom of recurring endocarditis, or valvular competence.

In our series the main focus was on tricuspid valve reconstruction and an optimal long-term functional result with no or only limited tricuspid insufficiency. Therefore, we implanted an annuloplasty ring in all patients undergoing tricuspid valve repair to avoid future tricuspid ring dilatation and resulting tricuspid insufficiency. Initial moderate insufficiency is well tolerated by the patients undergoing tricuspid valve repair for infective tricuspid endocarditis and generally improves with time [17]. Nevertheless, it is, in our opinion, necessary to stabilize valve geometry to achieve a long-term competent valve. This is especially crucial in patients with massive destruction of one or two leaflets, which necessitates extensive repair with resection of a leaflet or a commissuroplasty.

Implantation of an annuloplasty ring should add only a little risk for recurring endocarditis because it could be shown that the rate for spontaneous prosthetic endocarditis is very low in the tricuspid position. This finding can be explained by the fact that the infection most often only involves the free margin of the valve, including the leaflets, but only rarely the annular region itself. Local factors, such as differences in blood supply of the annular area and the surrounding myocardium, may account for these different manifestations of endocarditis among mitral, aortic, and tricuspid valves [24].

Our approach is also supported by the growing number of successful reports on mitral valve repair involving ring annuloplasty in active endocarditis. Since Dreyfus and coworkers [32] reported in 1990 one of the first series of mitral valve repair in active endocarditis, many authors [33–36] have confirmed not only the feasibility of mitral valve repair in the active phase of endocarditis but could also show that mitral valve repair is superior to mitral valve replacement in regard to event-free long-term survival and recurrence of endocarditis. Although the fear is that implantation of an annuloplasty ring might present additional risk for recurrent endocarditis, all authors implanted annuloplasty rings in the vast majority of these patients to prevent future annular dilatation. In five studies with a medium follow-up of between 23 and 73 months, no recurrence of endocarditis could be observed [25–29].

In our series, 2 patients in the reconstruction group experienced recurring endocarditis. However, in both patients endocarditis could be successfully treated by antibiotics alone, and no reoperation for endocarditis was required. In all patients in the reconstruction group, an acceptable functional result with regard to tricuspid valve competence could be achieved, and none of these patients developed any signs of right heart failure during follow-up related to tricuspid insufficiency.

The greatest management problem in patients with tricuspid valve endocarditis is the question of whether and when they need surgical intervention. Our recommendation for surgery is to wait, if possible, until the peak of serum levels of systemic signs of infection as well as the peak of clinical infective illness has been transgressed. Because of our experience, pressor support during and after surgery is excessive when the operation is performed during the height of clinical infective illness and can be substantially aggravated by the sequelae of substantially high doses of norepinephrine. As stated by Chan and associates [3], indications for surgery can be divided into definite reasons like persistent sepsis and significant congestive heart failure, probable reasons like large vegetation size, involvement of left-sided heart valve(s), gram-negative organisms, or candida, and reasons that are no indication for surgery by itself like persisting fever, recurrent pulmonary embolizations, and polymicrobial infections. We are in agreement with those statements, but think that owing to the advancements in echocardiography during the last decades, our decision whether to perform surgery or not was more directed by echocardiographic findings than in older reported series.

Like other published series, our study is necessarily limited by its retrospective nature and relatively small sample size. Unfortunately we cannot make any statement on the number of patients receiving medical treatment alone during the study period, as many patients are referred to our center solely for surgical repair of their active infective endocarditis. Therefore, we have no conclusive information about the total numbers of patients with this disease in the referring centers. Furthermore, cardiologists and infectious disease specialists from our institution were not able to provide absolute numbers, as these patients often have multiple morbidities and acute infective endocarditis is not the main diagnosis of their admission. They usually are referred for fever of unknown origin, dyspnea, or cardiac decompensation, for example.

The results of our study clearly demonstrate that in the vast majority of patients with active infective endocarditis, tricuspid valve reconstruction in conjunction with the use of an annuloplasty ring can be safely performed with good midterm results. This is true for both freedom of recurring endocarditis and acceptable valvular competence. Consequently, valve replacement should be the last option, especially in younger patients, and should only be considered if extensive valvular destruction renders reconstruction impossible.


   References
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
 References
 

  1. Pelletier Jr LL, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963–72 Medicine 1977;56:287-313(Baltimore).[Medline]
  2. Roberts WC, Buchbinder NA. Right-sided valvular infective endocarditisA clinicopathologic study of twelve necropsy patients. Am J Med 1972;53:7-19.[Medline]
  3. Chan P, Ogilby JD, Segal B. Tricuspid valve endocarditis Am Heart J 1989;117:1140-1146.[Medline]
  4. Arbulu A, Holmes RJ, Asfaw I. Surgical treatment of intractable right-sided infective endocarditis in drug addicts: 25 years experience J Heart Valve Dis 1993;2:129-137.[Medline]
  5. Bayer AS, Blomquist IK, Bello E, Chiu CY, Ward JI, Ginzton LE. Tricuspid valve endocarditis due to Staphylococcus aureus: correlation of two-dimensional echocardiography with clinical outcome Chest 1988;93:247-253.[Medline]
  6. Graham DY, Reul GJ, Martin R, Morton J, Kennedy JH. Infective endocarditis in drug addicts: experiences with medical and surgical treatment Circulation 1973;48(Suppl):37-41.[Abstract/Free Full Text]
  7. Arbulu A, Asfaw I. Tricuspid valvulectomy without prosthetic replacementTen years of clinical experience. J Thorac Cardiovasc Surg 1981;82:684-689.[Medline]
  8. Robin E, Thomas NW, Arbulu A, Ganguly SN, Magnisalis K. Hemodynamic consequences of total removal of the tricuspid valve without prosthetic replacement Am J Cardiol 1975;35:481-486.[Medline]
  9. Lange R, De Simone R, Bauernschmitt R, Tanzeem A, Schmidt C, Hagl S. Tricuspid valve reconstruction, a treatment option in acute endocarditis Eur J Cardiothorac Surg 1996;10:320-326.[Abstract]
  10. Bortolotti U, Tursi V, Fasoli G, Milano A, Frigato N, Casarotto D. Tricuspid valve endocarditis: repair with the use of artificial chordae J Heart Valve Dis 1993;2:567-570.[Medline]
  11. Durak DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findingsDukes Endocarditis Service. Am J Med 1994;96:200-209.[Medline]
  12. Cicalini S, Forcina G, De Rosa FG. Infective endocarditis in patients with human immunodeficiency virus infection J Infect 2001;42:267-271.[Medline]
  13. Miro JM, del Rio A, Mestres CA. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients Infect Dis Clin North Am 2002;16:273-295.[Medline]
  14. Heiro M, Helenius H, Makila S, et al. Infective endocarditis in a Finnish teaching hospital: a study on 326 episodes treated during 1980–2004 Heart 2006;92:1457-1462.[Abstract/Free Full Text]
  15. Mylonakis E, Calderwood SB. Infective endocarditis in adults N Engl J Med 2001;345:1318-1330.[Free Full Text]
  16. United Nations The evolution of the world drug problem United Nations World Drug Report 2006: United Nations Office on Drugs and Crime. 2006. pp. 31-50United Nations: Chapter 1.1.
  17. Mond HG, Irwin M, Morillo C, Ector H. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2001 Pacing Clin Electrophysiol 2004;27:955-964.[Medline]
  18. Mond HG. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 1997—Asian Pacific, Middle East, South America, and Canada Pacing Clin Electrophysiol 2001;24:856-862.[Medline]
  19. Tarng DC, Huang TP. Internal jugular vein haemodialysis catheter-induced right atrium endocarditis—case report and review of the literature Scand J Urol Nephrol 1998;32:411-414.[Medline]
  20. Bayer AS, Blomquist IK, Bello E, Chiu Cy, Ward JI, Ginzton LE. Tricuspid valve endocarditis due to Staphylococcus aureus Chest 1988;93:247-253.[Medline]
  21. Lange R, Hagl S, Sebening F, et al. Infektiöse endocarditisIn: Hombach V, editor. Kardiologie, Bd. 3, Kardiovaskuläre Chirurgie. Stuttgart: Schattauer; 1998. pp. 191-226.
  22. Banks T, Fletcher R, Ali N. Infective endocarditis in heroin addicts Am J Med 1973;55:444-451.[Medline]
  23. Yee ES, Ullyot DJ. Reparative approach for right-sided endocarditisOperative considerations and results of valvuloplasty. J Thorac Cardiovasc Surg 1988;96:133-140.[Abstract]
  24. Scully HE, Armstrong CS. Tricuspid valve replacementFifteen years of experience with mechanical prostheses and bioprostheses. J Thorac Cardiovasc Surg 1995;109:1035-1041.[Abstract/Free Full Text]
  25. Kang CH, Ahn H, Kim KH, Kim KB. Long-term result of 1144 CarboMedics mechanical valve implantations Ann Thorac Surg 2005;79:1939-1944.[Abstract/Free Full Text]
  26. Dalrymple-Hay MJ, Leung Y, Ohri SK, et al. Tricuspid valve replacement: bioprostheses are preferable J Heart Valve Dis 1999;8:644-648.[Medline]
  27. Van Nooten GJ, Caes F, Taeymans Y, et al. Tricuspid valve replacement: postoperative and long-term results J Thorac Cardiovasc Surg 1995;110:672-679.[Abstract/Free Full Text]
  28. Kay JH, Maselli-Campagna G, Tsuji KK. Surgical treatment of tricuspid insufficiency Ann Surg 1965;162:53-58.[Medline]
  29. Lai DTM, Chard RB. Commissuroplasty: a method of valve repair for mitral and tricuspid endocarditis Ann Thorac Surg 1999;68:1727-1730.[Abstract/Free Full Text]
  30. d’Udekem Y, Sluysmans T, Rubay JE. Tricuspid valve repair for tricuspid valve endocarditis after Fallot repair Ann Thorac Surg 1997;63:830-832.[Abstract/Free Full Text]
  31. Carozza A, Renzulli A, De Feo M, et al. Tricuspid repair for infective endocarditis: clinical and echocardiographic results Tex Heart Inst J 2001;28:96-101.[Medline]
  32. Dreyfus G, Serraf A, Jebara VA, et al. Valve repair in acute endocarditis Ann Thorac Surg 1990;49:706-713.[Abstract]
  33. Fuzillier JF, Acar C, Jebara VA, et al. Plastie mitrale au cours de la phase aigue de léndocardite Arch Mal Coeur 1993;86:197-201.[Medline]
  34. Podesser BK, Rödler S, Hahn R, et al. Mid-term follow-up of mitral valve reconstruction due to active infective endocarditis J Heart Valve Dis 2000;9:335-340.[Medline]
  35. Senni M, Merlo M, Sangiori G, et al. Mitral valve repair and transesophageal echocardiographic findings in a high-risk subgroup of patients with active, acute infective endocarditis J Heart Valve Dis 2001;10:72-77.[Medline]
  36. Sternik L, Zehr KJ, Orszulak TA, Mullany CJ, Daly RC, Schaff HV. The advantage of repair of mitral valve in acute endocarditis J Heart Valve Dis 2002;11:91-98.[Medline]

Related Article

Invited commentary
James S. Gammie
Ann. Thorac. Surg. 2007 84: 1949. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Eur Heart JHome page
Endorsed by the European Society of Clinical Micro, Authors/Task Force Members, G. Habib, B. Hoen, P. Tornos, F. Thuny, B. Prendergast, I. Vilacosta, P. Moreillon, M. de Jesus Antunes, et al.
Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC)
Eur. Heart J., October 1, 2009; 30(19): 2369 - 2413.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. S. Gammie
Invited commentary
Ann. Thorac. Surg., December 1, 2007; 84(6): 1949 - 1949.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Martin Czerny
Ernst Wolner
Rainald Seitelberger
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gottardi, R.
Right arrow Articles by Seitelberger, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gottardi, R.
Right arrow Articles by Seitelberger, R.
Related Collections
Right arrow Valve disease
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS