Successful Handmade Monobloc Aortomitral Valve Replacement for Extensive Aortic Root Abscess

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Prosthetic Valve Complications

Background:

• Aortic root abscess is a severe complication of infective endocarditis, particularly with prosthetic valves.
• Complete surgical débridement of infected tissue is crucial for successful management.
• Prosthetic aortic valve endocarditis presents unique challenges due to complex anatomy and potential for extensive abscess formation.

Observation:

• A 37-year-old male patient presented with an extensive aortic root abscess secondary to prosthetic aortic valve endocarditis.
• The primary lesion involved aortomitral continuity extending to the commissure between the left and right coronary cusps.
• The abscess affected the left and noncoronary aortic sinuses, necessitating thorough débridement.

Findings:

• Surgical débridement was performed to address the extensive aortic root abscess.
• A unique, handmade aortomitral monobloc valve was utilized for reconstruction of the aortic annulus beneath the left coronary artery.
• Aortic annuloplasty was omitted in this specific reconstruction approach.

Implications:

• This case demonstrates the successful application of a custom-designed aortomitral monobloc valve for complex aortic root abscesses.
• The technique facilitated complete débridement in a challenging anatomical scenario.
• This approach may offer a viable solution for extensive root abscesses in prosthetic valve endocarditis, potentially improving patient outcomes.