[Experience in surgical management for active aortic valve endocarditis with periannular abscess--outcome of abscess...

Two patients with active aortic valve endocarditis and periannular abscess underwent surgical management. Both patients had bicuspid aortic valves. Involvement of the aortic annulus with the formation of the periannular abscess was found at one third circumference in the aortic annulus and extended to the sinuses of Valsalva. In one patient the periannular abscess ranged from the right side of the ostia of a left coronary artery to the right commissural region, and in another patient it existed at the left commissural region. the ostia of coronary arteries were separated from the inflammatory and necrotic tissue in both patients. The wall of periannular abscess could not be totally excised. Instead, debridement and transaortic patch closure of the abscess cavity were performed. In the former patient, partial resection of the aneurysmal wall of the abscess was performed and the remaining aortic wall was approximated with extra-luminal sutures supported by Teflon felt pledgets. However, in the latter patient, the plication of the abscess wall could not be performed. Prosthetic mechanical valve was implanted at the paraannular position by utilizing the patch. In the former patient it took a month and a half until the disappearance of the inflammatory reaction, and the echo free space could not be detected at the same place of the abscess cavity by the two-dimensional echocardiogram since early postoperative period. However, in the latter patient it took three months until the disappearance, and the echo free space had been existing at the same place for thirteen months after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)