Prosthetic Tricuspid Valve Endocarditis Treated With Homemade Core-Matrix Valve
Alexander Nagy, M.D., David Gant, PA-C, Paul Gera, M.D..
Monongalia General Hospital, Morgantown, WV, USA.
Patient Demographics: Patient is a 34 year old disabled white female.
Relevant History: The patient has a pertinent history of previous IV drug use and tricuspid valve endocarditis which was initially treated at another facility with tricuspid valve replacement with Carpentier-Edwards Magna valve. She presented to our facility seven months later with symptoms of SOB, cough, and prosthetic tricuspid valve endocarditis.
Pre-Operative Plan: Pre-operative plan was formulated in team approach with three weeks of pre-operative antibiotics followed by redo sternotomy and tricuspid valve replacement with homemade Core-Matrix tri-leaflet valve.
Discussion of what was actually done and the challenges, deaths and complications encountered. (Unless case is still pending): The infected prosthetic tricuspid valve was removed and annulus debrided. A circumferential running prolene was used to reinforce the annulus. A cylindrical Core-Matrix valve was fashioned and three "commissural" anchors were place in the right ventricle. The new valve annulus was sewn into place in running fashion. Coaptation was excellent, and postoperatively there was mild tricuspid regurgitation on TEE. No other abnormal findings on immediate post-op TEE. Five days postoperatively she was found to have mild to moderate aortic insufficiency which appeared to originate from between the noncoronary and right coronary cusp. It was concerning for a distortion of valve leaflet or aortic annulus by the tricuspid annular sutures. Decision was made not to attempt repair due to the nature of the original surgery.
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