The reconstruction of mitro-aortic continuity is an uncommon procedure occurring in around 1% of patients undergoing aortic valve replacement. It is performed more frequently in case of native (NVE) or prosthetic valve endocarditis (PVE). In case of PVE with para-valvular abscess, the infected tissue must be removed thoroughly to avoid risk of recurrent endocarditis . A patch reconstruction is also required to implant new valves.
At Cleveland Clinic, these operations are referred to as “Commando operations”, an indicator of the procedure's challenges .
We describe a successful broaden Commando procedure on a patient with a relapse of PVE of aortic valve and a destructive abscess of mitral annulus involving the interventricular septum, operated for the third time.
This case is part of a group of six patients treated at our Institution with extensive resection and reconstruction not only in case of infective disease, but also in presence of other conditions, such as cardiac tumors. In fact, in our series we adopted this procedure also for a locally invasive left atrial mixoma.
The last follow-up TT-Echo, performed at 1 year for all patients, shows normal functioning of newly implanted prosthetic valves, preserved LV function and no residual defects after reconstruction.
A broaden Commando procedure can be adopted in case of disruption of the mitro-aortic curtain or cardiac tissues due to infective endocarditis or other causes, such as cardiac tumors.
1U.O. Cardiochirurgia CCFM Milano