Related Experiment Video
Updated: May 12, 2026
14:14
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Recurrent prosthetic valve endocarditis with aortic-ventricular disruption: a surgical challenge
Basel Ramlawi1, Laura E White, Rachel J Santora
1Department of Surgery, The Methodist Hospital and Research Institute, Houston TX 77030, USA.
The Journal of Heart Valve Disease
|April 25, 2013
Summary
Prosthetic valve endocarditis (PVE) after aortic valve replacement can cause severe complications. A successful surgical strategy involving complete root excision and reconstruction, followed by delayed closure, led to recurrence-free survival in all patients.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Cardiac Surgery
Background:
- Prosthetic valve endocarditis (PVE) following aortic valve replacement (AVR) is rare but life-threatening.
- Complications include aortic root abscess, aorto-left ventricular (LV) disruption, and LV pseudoaneurysm, especially after prior aortic root replacement (ARR).
Observation:
- A case series identified five patients with PVE and previous ARR requiring valved conduit and aortic root replacement.
- These patients presented with aortic-left ventricular disruption and ventricular pseudoaneurysm.
Findings:
- All five patients survived complete redo aortic root excision and reconstruction with a valved conduit and coronary reimplantation.
- Delayed sternal closure with mediastinal packing and omental flap closure in four cases resulted in successful outcomes.
- All patients were discharged and remained recurrence-free.
Implications:
- Aortic-left ventricular disruption secondary to PVE after ARR can be successfully managed.
- The described surgical strategy, including complete infected material excision, redo aortic root replacement, and delayed omental flap closure, is effective.
- This approach offers a viable solution for complex PVE cases post-aortic root surgery.
Related Concept Videos
01:18Endocarditis III: Medical Management
Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
01:25Endocarditis I: Introduction
Introduction:Endocarditis is the infection of the endocardium, the inner lining of the heart and its valves. When the heart muscle is involved, the condition is termed myocarditis, while an infection of the outer lining is called pericarditis. Infective endocarditis (IE) primarily affects the endocardium, where pathogens adhere to the valves or lining, forming vegetation that can lead to severe complications. Infective endocarditis occurs when microorganisms, usually bacteria from other body...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
01:15Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:26Mitral Stenosis III: Medical Management
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...