Management for Active Infective Endocarditis with extensive aortic root abscess

Abstract Background Bicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1–2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality. Case summary We report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up. Discussion This is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The ‘take away’ message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.

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Clickbait: A Rare Case of Monomorphic Ventricular Tachycardia and Clicking Sensation without Infectious Presentation Revealed as Infective Endocarditis with Aortic Root Abscess

American Journal of Medical Case Reports ◽

10.12691/ajmcr-9-11-1 ◽

2021 ◽

Vol 9 (11) ◽

pp. 522-526

Author(s):

Mahmoud S. Ahmed ◽

Mouhamed Nashawi ◽

Toka Amin ◽

Mahmoud Ahmad ◽

Mujahed Abualfoul

Keyword(s):

Ventricular Tachycardia ◽

Infective Endocarditis ◽

Aortic Root ◽

Rare Case ◽

Monomorphic Ventricular Tachycardia ◽

Aortic Root Abscess

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Perioperative Evaluation of Infective Endocarditis Via Multimodality Imaging for the Surgical Management of Aortic Root Abscess

Cureus ◽

10.7759/cureus.17817 ◽

2021 ◽

Author(s):

Sudhakar Kinthala ◽

Akhila Yarramneni ◽

Jordan Huang ◽

Natesh Yepuri ◽

Poovendran Saththasivam ◽

...

Keyword(s):

Infective Endocarditis ◽

Surgical Management ◽

Aortic Root ◽

Multimodality Imaging ◽

Aortic Root Abscess

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Prevalence and predictors of aortic root abscess among patients with left-sided infective endocarditis: a cross-sectional comparative study

The Egyptian Heart Journal ◽

10.1186/s43044-020-00098-6 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Kareem Mahmoud ◽

Tarek Hammouda ◽

Hossam Kandil ◽

Marwa Mashaal

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Aortic Valve ◽

Aortic Root ◽

Demographic Data ◽

Paravalvular Leak ◽

Imaging Data ◽

Mechanical Prosthesis ◽

Paravalvular Leakage ◽

Aortic Root Abscess

Abstract Background Aortic root abscess (ARA) is a major complication of infective endocarditis that is associated with increased morbidity and mortality. Limited data are present about patient characteristics and outcomes in this lethal disease. We aimed to study the clinical and echocardiographic characteristics of patients with ARA compared to patients with left-sided infective endocarditis without ARA. We included patients with a definite diagnosis of left-sided infective endocarditis according to modified Duke’s criteria. The patients were classified into two groups according to the presence of ARA (ARA and NO-ARA groups). All the patients were studied regarding their demographic data, clinical characteristics, laboratory and imaging data, and complications. Results We included 285 patients with left-sided infective endocarditis. The incidence of ARA was 21.4% (61 patients). Underlying heart disease, mechanical prosthesis, bicuspid aortic valve, and prior IE were significantly higher in ARA. The level of CRP was higher in ARA (p = 0.03). ARA group showed more aortic valve vegetations (73.8% vs. 37.1%, p < 0.001), more aortic paravalvular leakage (26.7% vs. 4.5%, p < 0.001), and less mitral valve vegetations (21.3% vs. 68.8%, p < 0.001). Logistic regression analysis showed that the odds of ARA increased in the following conditions: aortic paravalvular leak (OR 3.9, 95% CI 1.2–13, p = 0.03), mechanical prosthesis (OR 3.6, 95% CI 1.5–8.7, p = 0.005), aortic valve vegetations (OR 3.0, 95% CI 1.2–8.0, p = 0.02), and undetected organism (OR 2.3, 95% CI 1.1–4.6, p = 0.02), while the odds of ARA decreased with mitral valve vegetations (OR 0.2, 95% CI 0.08–0.5, p = 0.001). We did not find a difference between both groups regarding the incidence of major complications, including in-hospital mortality. Conclusion In our study, ARA occurred in one fifth of patients with left-sided IE. Patients with mechanical prosthesis, aortic paravalvular leakage, aortic vegetations, and undetected organisms had higher odds of ARA, while patients with mitral vegetations had lower odds of ARA.

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Mechanical Prosthetic Valve Sparing for Aortic Root Abscess Complicated by Infective Endocarditis

Texas Heart Institute Journal ◽

10.14503/thij-19-7059 ◽

2020 ◽

Vol 47 (4) ◽

pp. 280-283

Author(s):

Ahmed Ahmed ◽

Ayman Ammar ◽

Yasser Elnahas ◽

Mohammed Abd Al Jawad

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Root ◽

Prosthetic Valve ◽

Paravalvular Leak ◽

Mechanical Aortic Valve ◽

Aortic Root Abscess ◽

Mechanical Prosthetic Valve ◽

Valve Sparing

Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition. From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve. We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (≤30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicemia, and multisystem organ failure. At 1-year follow-up, the 18 surviving patients (90%) were symptom free and had a well-functioning mechanical aortic valve with no paravalvular leak. We conclude that, in certain patients, our technique for managing aortic root abscess and sparing the mechanical aortic valve is a safe and less time-consuming approach with relatively low mortality and encouraging midterm follow-up outcomes.

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