Surgical treatment for left ventricular-aortic discontinuity and Gerbode defect with endocarditis

An extensive infection of the native aortic or prosthetic valve beyond the aortic annulus could be complicated with various types and degrees of tissue destruction. The left ventricular-aortic discontinuity resulting from extensive infective endocarditis often necessitates pericardial reconstruction of the left ventricular outflow tract and subsequent aortic root replacement. Furthermore, if the membranous ventricular septum is involved with infective tissue destruction, communication between the left ventricle and right atrium, known as a Gerbode defect, and complete atrioventricular block could occur. Surgical reconstruction of these complex pathologies is challenging, with high mortality and morbidity. Herein, we present a rare case of prosthetic valve endocarditis complicated with both left ventricular-aortic discontinuity and an acquired Gerbode defect. At the time of surgery, left ventricular outflow tract reconstruction and the technically more demanding aortic root replacement were considered inevitable because of extensive tissue destruction. However, we performed circumferential left ventricular outflow tract reconstruction with a xenopericardial patch and supra-annular aortic valve replacement using the Solo Smart bovine pericardial stentless valve as a technically less demanding alternative to aortic root replacement. The postoperative course was uneventful, and the patient is well 1 year postoperatively, without valvular dysfunction and recurrent infection.