Two-dimensional echocardiographic identification of complicated aortic root endocarditis: implications for surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Infective endocarditis can lead to severe aortic valve and root complications.
• Accurate pre-operative assessment of these complications is crucial for surgical planning.

Purpose of the Study:

• To evaluate the utility of two-dimensional echocardiography in detecting aortic root complications in patients with aortic valve endocarditis.
• To correlate echocardiographic findings with surgical outcomes and guide treatment strategies.

Main Methods:

• Two-dimensional echocardiography was used to assess nine patients with aortic valve endocarditis.
• Echocardiographic findings of aortic root complications (abscess, aneurysm) and aorto-left ventricular discontinuity were quantified.
• Findings were correlated with surgical procedures and patient follow-up.

Main Results:

• Echocardiography accurately identified aortic root complications and the extent of aorto-left ventricular discontinuity.
• Prosthetic valve endocarditis cases exhibited greater aorto-left ventricular discontinuity (173 +/- 55 degrees) compared to native valve endocarditis (100 +/- 17 degrees).
• Echocardiographic findings aided in determining the need for aortic valve replacement versus composite aortic valve and root replacement.

Conclusions:

• Two-dimensional echocardiography is a valuable tool for diagnosing aortic annular abscess and mycotic aneurysms in aortic valve endocarditis.
• The degree of aorto-left ventricular discontinuity, particularly in prosthetic valve endocarditis, predicts the complexity of surgical repair.
• Echocardiographic assessment facilitates appropriate surgical planning and management of these complex cases.