Aorto-Mitral Curtain Reconstruction with Multiple Bovine Pericardial Patches: A Case of Multiple Valve Infective Endocarditis

Invasive infective endocarditis (IE) with abscess formation involving the intervalvular fibrous body (IFB) between the aortic and mitral valves or aorto-mitral curtain (AMC) can make surgical repair and reconstruction a particularly complex and high-risk surgical procedure. Tirone David initially described re-establishment of ‘neo-aortomitral curtain’ continuity through the use of bovine pericardial or Dacron fabric patches, which can range from a ‘Hemi-Commando procedure’ allowing for sparing of the anterior mitral leaflet (AML) free edge, to a much more extensive ‘Commando’ or ‘UFO’ procedure, as described by the Cleveland Clinic and Leipzig group, respectively (1,2). The Commando procedure is associated with high early and late mortality rates due to the invasiveness of the surgery and critical status of the patients requiring surgery, and therefore where there is sparing of the free edge of the anterior mitral leaflet in cases of invasive IE with AMC destruction, we have demonstrated that “neo-aortomitral continuity” can successfully be restored using patch repair approach to AMC reconstruction without need for double-valve replacement (3,4).