Commissuroplasty: a method of valve repair for mitral and tricuspid endocarditis

Background. We describe our experience with a technique of cusp commissuroplasty to reconstruct atrioventricular valves damaged by endocarditis of the commissure and adjacent cusps. Methods. We operated on 3 patients with mitral endocarditis and one patient with previous tricuspid endocarditis. Infected leaflet tissue was excised from each side of the commissure, leaving a defect between one quarter and one third of the valve area. Using the technique of valve commissuroplasty, leaflet remnants were reapposed at the cut edges to obliterate the commissure. The residual -shaped defect between the apposed leaflets and annulus was either closed directly or patched with pericardium, depending on the size of the defect. Results. Constructing unicommissural mitral and bicuspid tricuspid valves restored leaflet continuity. One patient was lost to follow-up. Postoperative echocardiography performed at a mean interval of 14.7 months showed competent and nonobstructed valves. There was no recurrent endocarditis at a mean follow-up time of 15.7 months. Conclusions. The technique of cusp commissuroplasty can be used to reconstruct atrioventricular valves that have been damaged by endocarditis of the commissure and adjacent cusps.