Competent mitral valve after annulus ring removal for infective endocarditis.

The mitral annulus plays an essential role in mitral valve (MV) competency. When surgical intervention is needed, the placement of an annular ring is considered a major component of MV repair. However, the use of a foreign material increases the risk of infectious and thromboembolic complications and is problematic in children as it does not allow for annular growth. Herein is reported a case of infective endocarditis affecting a mitral ring that was implanted to treat severe mitral valve regurgitation (MR) some 10 years earlier. Surgery was performed to remove the MV vegetation, and subsequent echocardiography revealed only trace MR. The concept that the ring may be needed for a limited period of time to induce valve remodeling is consistent with new data on biodegradable rings. These rings degrade over months, inducing dense fibrous tissue that replaces the ring and maintains valve competency. The present case is one of the first human examples to support the potential efficacy of a biodegradable ring.