Active infective endocarditis after mitral valve repair

A 22-year-old man was diagnosed with active mitral endocarditis 14 months after mitral valve repair. The responsible organism was methicillin-resistant Staphylococcus epidermidis . Transthoracic echocardiography showed an 8-mm patch of vegetation adhering to the anterior part of the artifcial ring. Although antibiotics (piperacillin, minocycline, imipenem/cilastatin, and ampicillin) were administered, the vegetation grew to 30 mm. Reoperation was performed 35 days after the diagnosis. Before surgery, there was mild mitral regurgitation without congestive heart failure. Re-repair was performed by removing the vegetation and the artificial ring, and mattress sutures repaired the circumferential sulcus formed by the artificial ring. Teicoplanin and minocycline were administered for 6 weeks. At 20 months, infective endocarditis was absent. Residual mitral regurgitation has been consistently mild. Although active mitral endocarditis after mitral valve repair is rare, prompt reoperation should be considered if the responsible organism is drug-resistant and infection spreads to the artificial ring.