Periannular Complications in Infective Endocarditis Involving Prosthetic Aortic Valves

2015 ESC Guidelines for the management of infective endocarditis

“…Do powikłań okołozastawkowych należą: powstawanie ropni, tętniaków i przetok (zdefiniowane w tabeli 11) [223,224].…”

“…Inne powikłania wynikające z szerzenia się zakażenia występują rzadziej i mogą obejmować powstanie ubytku w przegrodzie między-komorowej, blok przedsionkowo-komorowy trzeciego stopnia i ostry zespół wieńcowy [223,224,234].…”

Characterization of 18 F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves

“…PVE is associated with an in-hospital mortality rate of 20% to 40% and is even higher when the infecting agent is Staphylococcus aureus. [3][4][5][6] Such a high mortality rate is at least in part due to a delay in treatment initiation because of the difficulty in diagnosing infection on prosthetic valves. The direct evidence of vegetation or perivalvular complications of infection-a major criterion in the Duke-Li diagnostic criteria 7 -relies on echocardiography, but the presence of composite material generating acoustic shadowing results in inconclusive results in a substantial proportion of patients 8 and loss of diagnostic accuracy in PVE compared with native valve endocarditis, both for transthoracic and transesophageal echocardiography.…”

Aorto-right ventricular fistula: An early complication of aortic valve replacement

“…In the other hand, ARV fistula may follow a rupture of a congenital aortic sinus aneurysm [11] .When occurring in infective endocarditis, ARV fistula is associated with gloomy prognosis because of higher mortality (55% according to a series of 346 consecutive cases of infective endocarditis) [12] . This complication is encountered in 2% in native valve endocarditis [9,13] and 3% in prosthetic valve endocarditis [14] . Iatrogenic origin of ARV fistulas are increasingly reported, mainly with the development of interventional procedures.…”

“…Indeed, ARV fistula may follow either surgical aortic valve replacement [1,15] or percutaneous aortic valve implantation (TAVI) [16] . Several mechanisms may lead to cardiac shunts during aortic valve surgery including unintentional injury to the membranous septum sustained during dissection below the noncoronary cusps, perivalvular damage attributable to improper retraction and excessive and aggressive debridement of bulky areas of calcification from the aortic annulus [5][6][7][8][9][10][11][12][13][14][15][16][17] and/or pseudo-aneurysm formation secondary to degenerative changes at the aortotomy line and the pseudo-aneurysm's eventual rupture into the RV [1] . Lorenz et al proposed ischemic necrosis because of inappropriate suturing of the mechanical valve if the membranous portion of the ventricular septum is included in the prosthetic valve suture line [5] .…”