A Case of Aortic Root Replacement and Patch Closure for Aorto-Right Ventricular Fistula Secondary to Infective Endocarditis
10.4326/jjcvs.43.118
- VernacularTitle:大動脈-右室交通を合併した感染性心内膜炎に対し大動脈基部置換術およびパッチ閉鎖術を施行した1例
- Author:
Hiroyuki Seo
;
Hiromichi Fujii
;
Takanobu Aoyama
;
Yoshikado Sasako
- Publication Type:Journal Article
- Keywords:
infective endocarditis;
annular abscess;
aorto-right ventricular fistula;
aortic root replacement;
patch closure
- From:Japanese Journal of Cardiovascular Surgery
2014;43(3):118-123
- CountryJapan
- Language:Japanese
-
Abstract:
A 62-year-old man with a history of insulin-dependent diabetes mellitus was admitted to our hospital because of a high-grade fever and general fatigue. Laboratory data showed evidence of inflammation and Streptococcus pneumoniae was identified in the blood cultures. Transthoracic echocardiography revealed vegetations on the right coronary cusp of the aortic valve and septal leaflet of the tricuspid valve, and an aorto-right ventricular fistula secondary to abscess formation in the aortic annulus. We diagnosed active infective endocarditis with an aorto-cavity fistula and performed an emergency operation. The infected tissue was curetted as much as possible and the fistulous openings in the right ventricle and aortic root were closed using bovine pericardial patches. We subsequently performed aortic annular reconstruction and aortic full-root replacement using a Freestyle® stentless valve. Although a permanent pacemaker was implanted to treat a complete atrioventricular block, the postoperative course was uneventful and the C-reactive protein level normalized. He was discharged on the 46th postoperative day. Postoperative echocardiography revealed no signs of valve dysfunction, recurrent endocarditis, or residual abscess cavity and shunt. Infective endocarditis with abscess formation complicated by a fistula formation between the cardiac chambers is rare, and surgical treatment for this is challenging. In such cases, both radical debridement of the infected tissue and precise closure of the fistulous tract are essential.
