Surgical management of aortic root abscess: A 13-year experience in 172 patients with 100% follow-up

Leontyev, Sergey; Borger, Michael A.; Modi, Paul; Lehmann, Sven; Seeburger, J.; Doenst, T.; Mohr, Friedrich W.

doi:10.1016/j.jtcvs.2010.10.064

Cited by 69 publications

(54 citation statements)

References 22 publications

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“…However, the late mortality and recurrent infection was very low, which is quite different from other previously published studies 1,4,9. Several factors might have influenced the results: first, less virulent streptococci were the offending microorganism in more than half of our patients, which is less virulent.…”

Section: Discussioncontrasting

confidence: 89%

“…In contrast to infective endocarditis without root abscess, urgent surgical treatment to eradicate the infected tissue is mandatory to successfully treat patients with root abscess. Also, delay in surgical treatment often results in periannular complications such as fistula to other cardiac chambers, false aneurysms, heart block, destruction of intervalvular fibrous bodies, and involvement of mitral valve 4,5,6,7,8. Therefore, once an aortic root abscess is detected, urgent surgery is required, as antibiotics alone will fail to control the infection and delay in surgical treatment may cause fatal complications; such cases usually require a more complex operation.…”

Section: Discussionmentioning

confidence: 99%

“…Although advances in antimicrobial therapies have been achieved, approximately one-third of patients with active infective endocarditis require surgery to save the patient's life and eradicate the infection, for which the overall outcomes remain poor 1,2,3,4. Endocarditis affecting the aortic valve combined with abscess formation is particularly challenging to treat, and requires aggressive diagnostic and therapeutic approaches because of severe complications associated therewith, such as heart block, destruction of intervalvular fibrosa involving the mitral valve, fistula to other cardiac chambers, aortic pseudoaneurysm formation, and extrinsic compression of coronary arteries 5,6,7,8…”

Section: Introductionmentioning

confidence: 99%

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Surgical Experience with Infective Endocarditis and Aortic Root Abscess

2014

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PurposeThis study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation.Materials and MethodsBetween February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50±14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed.ResultsThere were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8±11.8 mm to 52.6±8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4±12.0% to 49.8±16.5%, p<0.001). The mean follow-up duration was 68.7±40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2±0.7 to 1.2±0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%.ConclusionSurgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Experience with Infective Endocarditis and Aortic Root Abscess

2014

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“…In our patient, there was ruptured sinus of Valsalva aneurysm and a small aortic root abscess with small multiple vegetations 2-3 mm in size. The prognosis of infective endocarditis depends upon whether the infected valve is native or prosthetic [14,15,16]. The type & virulence of the microorganism and resistance of the host are important in determining the fate of IE; it's complications like paravalvular abscess, cardiac fistulas and severe destruction of the native aortic valve.…”

Section: Discussionmentioning

confidence: 99%

Rupture of Sinus of Valsalva with Endocarditis and Aortic Root Abscess

Ali¹,

Waseem²,

Arif³

2017

SOJMID

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A ruptured sinus of Valsalva aneurysm rarely accompanies the aortic valve endocarditis. A 40 year old female presented with low threshold exertional dyspnea and fever. Transthoracic and transesophageal echocardiography showed ruptured sinus of Valsalva aneurysm in right ventricle with multiple vegetations at the aortic root. Initial blood cultures were negative and an empirical antibiotic therapy was started. Patient was operated for surgical repair of sinus of Valsalva aneurysm.An aortic root abscess with rupture of sinus of Valsalva was found at operation. However, postoperatively she developed sepsis and multiorgan failure leading to her death.

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“…Surgical intervention, performed in 18 of the 21 cases, ranged from lone abscess resection to valve replacement and coronary artery bypass grafting. Leontyev and colleagues 21 reviewed 172 cases of surgically repaired IE complicated by abscess formation and reported a 30-day mortality rate of 25%, with mean 1-and 5-year survival rates of 55% ± 4% and 50% ± 4%, respectively. Of these cases, 76 (44%) involved prosthetic aortic valves, which is comparable to our own reviewed percentage.…”

Section: Discussionmentioning

confidence: 99%

Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

Jenny¹,

Almanaseer²

2014

Texas Heart Institute Journal

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1 Major clinical features of IE include fever, systemic emboli, congestive heart failure, and renal insufficiency; however, classic peripheral manifestations of endocarditis-splinter hemorrhages, Osler nodes, Roth spots, and Janeway lesions-are observed less often. Rarely is cardiac ischemia or myocardial infarction caused by coronary emboli or obstruction of the coronary ostia by large vegetations. Coronary artery compression by abscess formation, although even less frequent, is important to consider in patients who present with atypical features of an acute coronary syndrome. We discuss the case of an elderly patient in whom these features occurred, and we briefly review the relevant medical literature. Case ReportA 73-year-old woman with a history of aortic stenosis, atrial fibrillation, diabetes mellitus, and a chronic gastrocutaneous fistula and sacral decubitus ulcer presented with sudden-onset back pain and shortness of breath. In the emergency department, she had a temperature of 102.2 °F, a heart rate of 123 beats/min, and a blood pressure of 119/50 mmHg. Physical examination revealed a normal S 1 and S 2 and a harsh grade 2/6 systolic ejection murmur that radiated to the carotid arteries. Also noted were a fistula in the left upper quadrant that drained serous fluid, and a healing sacral ulcer with minimal skin breakdown and no signs of gangrene. Laboratory results included a troponin level of 0.746 µg/L, a creatinine kinase level of 140 U/L, and a creatinine kinase-MB fraction of 11.9 ng/mL. A 12-lead electrocardiogram showed ST-segment elevation in leads V 1 , V 2 , and III, with ischemic-appearing ST-segment depression in leads I and aVL (Fig. 1). Urgent coronary angiograms revealed a mildly dilated ascending aorta and a long, tubular area of the right coronary artery with narrowing that extended almost to the crux ( Fig. 2A). A possible flap suggested right coronary artery dissection, and the presumed diagnosis was coronary dissection. Computed tomographic angiograms of the ascending and descending aorta showed no dissection but revealed an irregular collection of contrast medium along the anterior right side of the aortic annulus (Fig. 2B).The patient's history of chronic infection and elevated white blood cell count on presentation (21 ×10 9 /L) raised concerns of IE, so further imaging of the heart was performed. Two-dimensional transthoracic echocardiograms (TTE) revealed a thickened, calcified, severely stenotic aortic valve with apparent vegetations. A 2-dimensional transesophageal echocardiogram (TEE) revealed vegetations on the aortic valve Case Reports

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Surgical management of aortic root abscess: A 13-year experience in 172 patients with 100% follow-up

Abstract: The surgical treatment of aortic root abscess remains a challenge with relatively high perioperative morbidity and mortality, although long-term survival is satisfactory.

Cited by 69 publications

References 22 publications

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

Rupture of Sinus of Valsalva with Endocarditis and Aortic Root Abscess

Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

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