Operative characteristics
The patients’ intraoperative characteristics are summarized in Table 2. In Patient 1, the A2 and P2 segments flailed with large vegetations. Blood culture showed methicillin-resistant coagulase-negative staphylococci. The patient’s mitral valve repair was performed by A2 leaflet reconstruction with autologous pericardium, two pairs of artificial chordae to the margin of the A2 pericardium, P2 quadrangular resection and suture, and mitral annuloplasty using a 26-mm Carpentier-Edwards Physio II ring (Edwards Lifesciences, Irvine, CA, USA) (Figure 2a). Patient 2 had destructive infective endocarditis of the P3 segment caused by a viridans streptococcus. The P3 scallop was completely resected and reconstructed with autologous pericardium combined with mitral annuloplasty using a 28-mm Carpentier-Edwards Physio II ring (Figure 2b). In Patient 3, A3 and P2–3 had been destroyed by a viridans streptococcus infection. We performed A3 leaflet and P2–3 scallop reconstruction with autologous pericardium, placement of three pairs of artificial chordae to each leaflet, and mitral annuloplasty using a 26-mm Carpentier-Edwards Physio II ring (Figure 2c). Patient 4 had infective endocarditis in the P2–3 segment due to a viridans streptococcus infection. Surgery was performed with P2–3 scallop reconstruction with autologous pericardium, placement of one pair of artificial chordae to the P3 pericardium, and mitral annuloplasty using a 32-mm Carpentier-Edwards Physio II ring (Figure 2d). In Patient 5, the A1–2 segment, anterior commissure leaflet, and P1–2 segment had been extensively destroyed by a methicillin-susceptible Staphylococcus aureus infection. The patient underwent A1–2 leaflet and P1–2 scallop reconstruction with autologous pericardium, placement of four pairs of artificial chordae to each pericardium, and mitral annuloplasty using a 28-mm Memo 3D ring (Sorin Biomedica Cardio S.r.L., Saluggia, Italy) (Figure 3). No patients showed evidence of annular abscess formation.