[Surgical treatment of aortic valve endocarditis associated with aortic root aneurysm and abscess]

Between Jan. 1979 and Mar. 1996, aortic root abscess and aneurysm were encountered in 10 (34.5%) of the 29 patients who underwent surgical treatment for the aortic valve endocarditis ; native valve endocarditis (NVE) in 8 and prosthetic valve endocarditis (PVE) in 2. Noncoronary sinus was involved in 8 (80%) of 10 patients, left coronary sinus destructed in one, and more than one sinus were involved in one. All patients underwent aortic valve replacement after repair of abscess or aneurysm with suture closure in 5, and patch closure in 3, and its resection in one. Aortic root reconstruction using a valved conduit was required for the repair of aortico-ventricular discontinuity followed debridement of the abscess cavity of almost entire annulus in one PVE patient who consequentry died of LOS and sepsis. There was no operative or postoperative death in the other patients, however, one female patient suddenly died 24 months after surgery. She underwent direct suture closure of left coronary sinus aneurysm and aortic valve replacement with a small-sized prosthetic valve. Suture dehiscence of the orifice of the aneurysm developed immediately after surgery. It is concluded that patch closure of aortic root aneurysm or abscess is recommended so as to avoid narrowing of left ventricular outflow tract and recurrence of aneurysm formation even if its orifice proved to be small.