Aortic-left ventricular discontinuity and aortic regurgitation from acute endocarditis

During the past 14 years, eight patients have had surgical intervention for acute aortic endocarditis and aortic-left ventricular discontinuity at our institution. Repair of the defect between the aorta and left ventricle was accomplished in two patients with interrupted horizontal pledgeted sutures placed through the left ventricular and aortic walls and through the ring of a valve prosthesis. In the remaining six patients the repair was done with the interposition of a Dacron patch graft between the left ventricle and the aorta, and then the valve prosthesis was sutured to the graft and to the remaining native aortic annulus. One patient died during the operation, one was lost to follow-up four months after operation, and one died of cerebral hemorrhage two years postoperatively. The remaining five patients have had from three months to four years of follow-up. Closure of large defects between the aorta and left ventricle with a patch graft and then suturing the aortic valve to the patch and to the remaining native aortic annulus allows debridement of all necrotic tissue, placement of the sutures through normal tissue, closure of the defect under no tension, and suturing of the new valve at its normal anatomic level. It also requires no surgical manipulation of the coronary arteries and allows completion of the procedure in the shortest time possible.