Undetected advantage of chordal preservation: restriction of prosthetic valve endocarditis

A young male patient who was operated for prosthetic mitral valve replacement admitted to our clinic at fourth postoperative month with loss of equilibrium, fatigue and fever. There were two vegetations on the anterior portion of the sewing ring and a large dehiscense area from the anterior annulus on echocardiography. Gram positive coccus was revealed in the gram colouring. Patient was taken to emergency operation with all these findings. When we excised both the prosthetic valve and native valve tissue, it was seen that infection was limited due to the chordal preservation in the prior operation. There was no clue for infection on the annulus and the anterior annulus was intact for valve re-replacement. We only applied pericardial patchplasty to the posterior annulus where we made a superficial debridement in order to create a smooth surface to enhance a difficult attachment zone for the microorganisms. It is very obvious that chordal preserved mitral valve replacement operation enhances and preserves the left ventricular function. Moreover chordal preservation technique may provide a better intact annulus and enough infection free area for reoperation due to infection.