Frozen elephant trunk procedure for extensive pneumococcal thoracic aortitis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Vascular Surgery

Background:

• Infectious arteritis presents diagnostic challenges due to insidious onset.
• Thoracic aortitis, particularly pneumococcal, requires prompt and effective management.
• Delayed diagnosis of infectious aortitis can lead to severe complications.

Observation:

• A 64-year-old woman presented with extensive pneumococcal thoracic aortitis.
• The patient underwent a frozen elephant trunk procedure for aortic arch repair.
• Aortic wall cultures confirmed Streptococcus pneumoniae infection.

Findings:

• Successful surgical repair of the thoracic aorta was achieved using the frozen elephant trunk technique.
• Prolonged aortic wall cultures remained positive for Streptococcus pneumoniae, indicating persistent infection.
• No recurrence of aortitis was observed at 36-month follow-up around the hybrid vascular graft.

Implications:

• The frozen elephant trunk procedure is a viable option for managing complex thoracic aortitis.
• Early diagnosis and aggressive treatment are crucial for favorable outcomes in infectious aortitis.
• Long-term surveillance is necessary to monitor for recurrence of infection in treated aortic aneurysms.