Application of the Konno procedure for infective endocarditis in native bicuspid aortic valve with annular abscess extending into the interventricular septum

Annular abscess is a serious complication of infective endocarditis, which often requires complex surgery and has a very high post-operative mortality rate. The Konno procedure involves valve annuloplasty for a narrow aortic annulus or left ventricular outflow tract stenosis in children; it is also performed for various cardiac conditions in adults. Here, we report a case of the Konno procedure performed in a patient with aortic valve infective endocarditis, with an annular abscess extending into the interventricular septum (IVS). A 58-year-old man who presented to our hospital with fever was diagnosed with aortic valve infective endocarditis caused by Streptococcus saccharolyticus. On echocardiography, an annular abscess in the direction of the IVS was detected, and surgery was planned. The Konno procedure was performed to secure an adequate surgical field and to debride and reconstruct the cavity created by the interventricular septal abscess. The patient was discharged uneventfully 29 days after surgery.

Case Study: Pneumococcal Prosthetic Valve Endocarditis with Mitral Annular Abscess Fistulised in the Left Atrium: An Uncommon Germ with Dramatic End

Background: Streptococcus pneumoniae is an infrequent cause of infectious endocarditis. Several case series have underscored the aggressive course of Streptocoque Pneumiae with acute clinical presentation, rapid valvular destruction, and high mortality despite appropriate antibiotic therapy. Case summary: We present a 74-year-old woman with previous aortic and mitral valve replacement 12 years ago, presented with a 5 days history of persistent fever and a red, hot, and swollen right knee. Atrial fibrillation was demonstrated on a 12-lead electrocardiogram. The initial echocardiography did not show any sign of endocarditis but in front of the clinical symptomatology the patient was put under probabilistic antibiotic therapy. in the meantime blood culture grew Streptocoque Pneumiae and then the antibiotic treatment was adapted. The sudden deterioration of the patient brought us back to control the heart by a transthoracic echocardiography, which revealed a mitral annular abscess fistulizing to the left atrium. the patient expired 30 days after admission from presumed severe sepsis and cardiogenic choc. Conclusion: Pneumococcal endocarditis in prosthetic valve is associated with very high mortality, especially when complicated by paravalvular abscess and other comorbidities. This case highlights the need for a carefull considered approach for fast and efficient care.

Native pulmonary valve infective endocarditis with septic embolisms and an infra-annular abscess

Infective endocarditis is nowadays one of the main indications for valvular surgery. When occurring in the right chambers of the heart, the tricuspid valve is the most commonly affected. Although this disease is usually present in injecting-drug abusers or patients with other predisposing risk factors, the incidence of native pulmonary valve infective endocarditis is the least frequent. This case report presents a 51-year-old patient with no relevant medical history that was admitted to our institution with sepsis. Further studies revealed a native pulmonary valve infective endocarditis complicated with infra-annular abscess and pulmonary septic embolisms. The following describes the clinical presentation of the case, echocardiograms, the surgical procedure, and the postoperative period. To date, few cases of native pulmonary valve infective endocarditis with no previous risk factors have been reported.

Is the Freedom SOLO Stentless Bioprosthesis a Useful Tool for Patients with Aortic Endocarditis and Aortic Annular Destruction?

Background The Freedom SOLO (FS) stentless bovine-pericardial prosthesis with a supra-annular implantation technique can be a viable option for patients with endocarditic annular destruction. We assessed early- and long-term outcomes following the use of this prosthesis in extensive aortic valve endocarditis. Methods From 2006 to 2016, 59 patients with extensive aortic endocarditis underwent aortic valve replacement (AVR) with FS (cumulative follow-up 263 patients-years) in three European centers; all patients presented annular tissue infection, while 54.3% of patients had annular abscess. Results Mean age was 66 ± 11 years and mean EuroSCORE I was 30.3% (standard deviation: 24.1%). In our series, 30.5% of patients had prosthetic valve endocarditis. Early mortality was 15.2% (nine patients). Estimated overall survival at 5 and 10 years was 68.9% (95% confidence interval [CI]: 62.8–75.0%) and 59.1% (95% CI: 66.8–81.2%), respectively. At 10-year survival, freedom from valve-related death was 83.7% (95% CI: 80.9–86.5%). No structural valve deterioration was reported in this series. Five patients (8.5%) had recurrent endocarditis during follow-up and two of them underwent reoperation. Survival freedom from reoperation and endocarditis at 10-year follow-up was 88.0% (CI: 80.4–95.6%) and 86.7% (CI: 80.5–92.9%), respectively. Conclusion FS stentless bioprosthesis is a valuable and simple option to achieve AVR in patients with extensive aortic annulus endocarditis. Although in this group of complex patients, early mortality remains considerably high, late survival outcomes are comparable to the more technically demanding homografts and conventional stentless bioprostheses, with low rates of endocarditis recurrence.