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Aneurysm I: Introduction01:30

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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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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...
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Aortic Regurgitation I: Introduction01:15

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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...
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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...
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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Aortic valve endocarditis complicated by proximal false aneurysm.

Pietro Giorgio Malvindi1, Elisa Mikus2, Luca Caprili3

  • 1Cardiac Surgery, Santa Maria Hospital, Bari, Italy.

Annals of Cardiothoracic Surgery
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Summary

Surgical repair of aortic valve endocarditis with aorto-ventricular discontinuity offers acceptable mid-term survival, despite significant early risks. This complex condition requires aortic root replacement and carries high rates of postoperative complications and mortality.

Keywords:
Endocarditisaortaaortic rootaortic valvereoperation

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Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis
  • Aortic Valve Disease

Background:

  • Aortic valve endocarditis with periannular complications, particularly aorto-ventricular discontinuity and false aneurysm, is a life-threatening condition.
  • This severe presentation often results from extensive tissue disruption, commonly linked to prosthetic valve infection.
  • Surgical repair is complex and associated with high mortality and morbidity.

Purpose of the Study:

  • To analyze the outcomes of surgical repair for infective aortic valve endocarditis complicated by pseudoaneurysm and aorto-ventricular discontinuity.
  • To evaluate early and mid-term patient outcomes following complex aortic root replacement procedures.

Main Methods:

  • Retrospective analysis of 32 patients undergoing surgery for infective aortic valve endocarditis with aorto-ventricular discontinuity and pseudoaneurysm.
  • All patients underwent aortic root replacement with a valve graft conduit.
  • Associated procedures included coronary artery bypass grafting (CABG) and mitral valve (MV) surgery in some patients.

Main Results:

  • Pre-discharge mortality was 22%. Postoperative complications occurred in 75% of cases, including low cardiac output (56%) and acute kidney injury (37%).
  • Five patients died from multiple organ failure, and one experienced a major neurologic deficit.
  • Five-year overall survival was 59%, with 89% freedom from endocarditis and reoperation.

Conclusions:

  • Patients with complicated aortic valve endocarditis often present with poor preoperative health.
  • Surgical treatment, while carrying significant risks, yields acceptable mid-term survival rates and satisfactory recovery.
  • Complex aortic root replacement is a viable, albeit high-risk, strategy for this severe pathology.