J Heart Valve Dis 1999;8:575â7. [5] Meyer SR, Nagendran J, Desai LS, Rayat GR, Churchill TA, Anderson CC et al. Decellularization reduces the immune ...
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(ii) In patients with active infective endocarditis, valve replacement with aortic and mitral allografts is successful in the early postoperative period. Conflict of interest: none declared.
REFERENCES [1] Byrne JG, Rezai K, Sanchez JA, Bernstein RA, Okum E, Leacche M et al. Surgical management of endocarditis: the society of thoracic surgeons clinical practice guideline. Ann Thorac Surg 2011;91:2012–9. [2] Acar C, Tolan M, Berrebi A, Gaer J, Gouezo R, Marchix T et al. Homograft replacement of the mitral valve. Graft selection, technique of implantation, and results in forty-three patients. J Thorac Cardiovasc Surg 1996;111:367–78. [3] Hlubocky J, Mokracek A, Novacek V, Vojacek J, Burkert J, Kochova P et al. Mechanical properties of mitral allografts are not reasonably influenced by cryopreservation in sheep model. Physiol Res 2011;60:475–82. [4] Mestres CA, Miro JM, Pare JC, Pomar JL. Six-year experience with cryopreserved mitral homografts in the treatment of tricuspid valve endocarditis in HIV-infected drug addicts. J Heart Valve Dis 1999;8:575–7. [5] Meyer SR, Nagendran J, Desai LS, Rayat GR, Churchill TA, Anderson CC et al. Decellularization reduces the immune response to aortic valve allografts in the rat. J Thorac Cardiovasc Surg 2005;130:469–76.
eComment. Preoperative computed tomography scan for the proper planning of surgery for heart valve endocarditis Authors: Roberto Gaeta Cardiac Surgery Chair, University of Messina, Messina, Italy doi: 10.1093/icvts/ivv067 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This nice report has presented a successful implantation of valve homografts for aortic and tricuspid valve infective endocarditis [1]. It has to be noted that an anomalous communication between the aorta and the right ventricle ( probably at level of the membranous part of the interventricular septum) is a quite unexpected finding during surgery. This fistula could have been detected preoperatively by a multidetector computed tomography (CT) scan. As reported by Nishimura et al. recently in the published 2014 AHA/ACC Guidelines for the Management of Patients With Valvular Heart Disease [2], the use of a preoperative CT scan has a level of evidence IIa, B class of recommendation in this clinical setting. This recommendation has two main practical implications: 1) screening for any periannular access, erosions and fistulae, which may well occur; 2) screening for any concomitant coronary artery disease if suspected by presence of any atherosclerosis risk factors. The relevance of the latter issue has been endorsed by us and others [3, 4]. We believe that in order to get correct surgical planning and have the homografts needed ready, a CT scan has to be preoperatively performed as a routine examination, both in elective and emergency cases of patients affected by infective endocarditis. Conflict of interest: none declared.
References [1] Ostrovsky Y, Spirydonau S, Shchatsinka M, Shket A. Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts. Interact CardioVasc Thorac Surg 2015;20:682–4. [2] Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JPIII, Guyton RA et al. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation 2014;129:2440–92. [3] Lentini S, Monaco F, Tancredi F, Savasta M, Gaeta R. Aortic valve infective endocarditis: could multi-detector CT scan be proposed for routine screening of concomitant coronary artery disease before surgery? Ann Thorac Surg 2009;87:1585–7. [4] Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324e2336. eReply. Re: Preoperative computed tomography scan for the proper planning of surgery for heart valve endocarditis Author: Mikalai Shchatsinka, Yury Ostrovsky, Siarhei Spirydonau and Aliaksandr Shket Republican Scientific and Practical Centre ‘Cardiology’, Minsk, Belarus doi: 10.1093/icvts/ivv089 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We are very grateful to Dr Gaeta for his interest in our article and for the comment. We would like to clarify several points regarding a preoperative computed tomography (CT) in this case. Firstly, the preoperative echo clearly showed us a communication between periaortic abscess and right ventricle and we were aware of this during surgery - it was not an intraoperative finding. Secondly, our patient was young (25 years old), so we had no reasons to perform CT in order to assess the patency of the coronary arteries. These were the only reasons why we did not perform a CT, which is without doubt a very valuable and potent diagnostic tool in patients with infective endocarditis, especially with periannular abscess and extensive tissue destruction. It should be mentioned that we now perform routine CT scans for patients receiving allografts, in order to assess the preoperative calcium scoring and also the calcification rate in the aortic tissue during the follow-up period. Conflict of interest: none declared. References [1] Ostrovsky Y, Spirydonau S, Shchatsinka M, Shket A. Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts. Interact CardioVasc Thorac Surg 2015;20:682–684. [2] Gaeta R. eComment. Preoperative computed tomography scan for the proper planning of surgery for heart valve endocarditis. Interact CardioVasc Thorac Surg 2015;20:684.
