Technique to treat extensive abscesses in double valve replacement for prosthetic valve endocarditis.

A 52-year-old man, who underwent double valve replacement for native valve infectious endocarditis, developed prosthetic valve endocarditis (PVE) at nine months after the initial operation. Operative findings revealed a wide aortic annular abscess, which extended through the intervalvular fibrous body to the mitral annulus. The infected mitral valve was excised through the atrial septum. After complete debridement of the abscess, a xenopericardial patch was sutured on to the abscessed area in the partially destroyed intervalvular fibrous body. Using this procedure, the affected annuli were reinforced and the abscessed area was isolated from the blood flow, reducing the probability of recurrent endocarditis. For valve implantation, 'anchoring' sutures were threaded externally through the aortic root, taking into consideration the fragility of the reconstructed annulus. The patient recovered with intensive administration of antibiotics and showed no sign of recurrent infection. The reinforcement of the intervalvular fibrous body and the use of 'anchoring' sutures may represent good alternatives for the surgical treatment of PVE.