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Persistent root abscess after emergency repair with an aortic homograft
M Ritter1, L von Segesser, R Jenni
1Division of Echocardiography, University Hospital, Zurich, Switzerland.
British Heart Journal
|November 1, 1994
Summary
A patient with Marfan syndrome and aortic graft developed Staphylococcus aureus endocarditis, leading to a large aortic root abscess. Despite surgery, the abscess persisted, resulting in fatal septic shock.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Marfan syndrome predisposes individuals to aortic complications, including root dilation and dissection.
- Previous aortic composite graft replacement with a Björk-Shiley mechanical prosthesis in a patient with Marfan syndrome.
- Staphylococcus aureus endocarditis presents a significant risk for prosthetic valve and aortic root infections.
Observation:
- A 58-year-old male patient with Marfan syndrome and an aortic composite graft presented with symptoms suggestive of endocarditis.
- Clinical presentation included a large aortic root abscess attributed to Staphylococcus aureus infection.
Findings:
- Despite aggressive surgical intervention, including debridement and aortic homograft implantation, a large aortic root abscess persisted postoperatively.
- Early transesophageal echocardiography confirmed the persistent abscess, indicating treatment failure.
Implications:
- This case highlights the challenges in managing complex aortic root abscesses in patients with connective tissue disorders and prosthetic material.
- Staphylococcus aureus endocarditis poses a severe threat to prosthetic aortic grafts, often requiring complex management strategies.
- The persistence of the abscess despite surgical intervention underscores the critical need for effective antimicrobial therapy and potentially re-intervention in such cases.