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Construction of Neo-Tricuspid Valve for Endocarditis Utilizing CorMartix ECM
J.W R. Bolton.
Stanford University, Henderson, NV, USA.

Objective: 30 year old epileptic male with complicated medical history including severe pancreatitis and Candida albicans candidemia following laparoscopic cholecystectomy presented to the emergency department with a 10 day history of worsening abdominal pain, nausea and vomiting and severe generalized body pain along with a 50 pound weight loss over the last 3 months and was found to have gram-positive cocci bacteremia with septic shock. CT scan suggested septic emboli to the lungs and spleen along with hepatosplenomegaly. Cardiac echocardiogram showed severe left ventricular hypokinesis and a grossly abnormal tricuspid valve with large vegetations and moderate regurgitation. Bubble study was positive for a right to left shunt. Due to worsening sepsis he was taken to the operating room for tricuspid valve debridement. Methods: Following cardiopulmonary bypass and cardioplegic cardiac arrest the right atrium was opened and revealed total destruction of the tricuspid valve with vegetations extending onto the papillary muscles and along the atrial septum into the coronary sinus. The valve was excised and all vegetations debrided. Due to his ongoing sepsis, seizure disorder and inability of tricuspid valve repair a neo-valve was fashioned by creating a tube of CorMatrix ECM patch 5.5 cm long around a 30cc syringe using a running 4-0 prolene suture. The distal tube was attached to the base of the three major papillary muscles with figure-of-eight 4-0 prolene sutures. The proximal tube was then attached to the tricuspid annulus with running 4-0 prolene with care to avoid the area of the A-V node. Intraoperative testing showed good neo-valve function with no evidence of regurgitation. Following separation from cardiopulmonary bypass the patient returned to sinus rhythm and intraoperative TEE confirmed excellent valve function without any leak. Results: During the remainder of his hospitalization his sepsis was cleared and repeat echocardiogram prior to discharge continued to show excellent neo-tricuspid valve function. Conclusions: The use of ECM patch to construct neo-valves may have a place in the treatment of valvular endocarditis.

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