Mitral Valve Replacement with Patch Repair of Posterior Annulus and CABGx1

68 year old lady with methicillin-resistant staphylococcus aureus (MRSA) native valve endocarditis. History of kidney transplant and islet cell transplant, type 1 diabetes, on immunosuppressive therapy. Presented with sepsis 8 weeks prior thought due to osteomyelitis of the foot. Treated with forefoot debridement and long course of iv antibiotics. Now represents with recurrent sepsis, positive blood cultures for MRSA. Repeat transesophageal echo imaging shows severe mitral valve regurgitation (previously trivial), perforation of the P3 region of the posterior mitral leaflet, and severe mitral posterior annular calcification with changes suspicious for annular infection. Small patent foramen ovale. Coronary angiography shows 90% ostial and 50% moderate right coronary stenoses. Preserved bi-ventricular function. Taken for urgent surgery: MV replacement and coronary bypass grafting x1 to RCA.

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