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Successful management of aortic valve endocarditis with associated periannular abscess and aneurysm
Insights
Extensive aortic valve endocarditis with abscesses requires complex surgical reconstruction. This approach, using valved conduits and grafts, offers a viable solution for aortic-ventricular discontinuity, with most patients surviving.
Area of Science:
- Cardiovascular Surgery
- Infective Endocarditis
- Cardiac Reconstruction
Background:
- Aortic valve endocarditis extending beyond the aortic root poses significant management challenges.
- Annular abscesses, particularly with prosthetic valves, complicate surgical intervention.
Observation:
- Four patients with extensive aortic root abscesses were treated over a four-year period.
- Cases involved native (1) and prosthetic (3) valves, with debridement and valved conduit replacement using coronary artery grafts.
Findings:
- Postoperative complications included conduction abnormalities, hemorrhage, and low cardiac output.
- Despite complications, all patients were discharged; long-term survival was observed in 75% of patients.
Implications:
- This surgical strategy allows for debridement and reconstruction in rare cases of endocarditis causing aortic-ventricular discontinuity.
- The use of prosthetic materials is necessary but facilitates safe and adequate repair.
Abstract:
Aortic valve endocarditis extending beyond the aortic root presents a particularly difficult management problem. During a four-year period we have seen four patients with extensive annular abscesses involving the native valve (in 1 patient) and prosthetic valves (in 3). In all these patients the aortic roots were debrided and valved conduits were replaced with coronary artery grafts while appropriate antibiotics were administered. Postoperative complications included conduction abnormalities, hemorrhage, and low cardiac output, but all 4 patients were discharged from the hospital. Two patients died, 1 of an unrelated disease at 13 months postoperatively and 1 of endocarditis at 16 months postoperatively. The two remaining patients are alive and well at 11 and 46 months postoperatively. We conclude that, in spite of the prosthetic material required, this procedure permits adequate debridement and safe reconstruction for the rare patient in whom endocarditis has resulted in aortic-ventricular discontinuity.