| Aortic Valve Replacement Following
Infectious Endocarditis Requiring Re-Operation Three Times |
(Department of Cardiovascular Surgery, Rakuwakai
Otowa Hospital, Kyoto, Japan and Department of Cardiovascular
Surgery, Kyoto University*, Kyoto, Japan)
| Nozomu Sasahashi |
Kazunobu Nishimura* |
Nobushige Tamura |
| Koji Ueyama |
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A 47-year-old man with active aortic
valve endocarditis underwent direct closure of a paraannular
abscess and valve replacement. Methicillin-resistant Staphylococcus
aureus was isolated from his blood culture preoperatively.
Because of a postoperative paravalvular leak (PVL) and an echo-free
space suggesting a residual cavity, he was reoperated for patch
closure of the aneurysm and prosthetic valve replacement. However,
the PVL and paraannular cavity were still observed after the
2nd surgery. At the 3rd operation, prosthetic valve detachment
along one fourth of its circumference was confirmed, and the
cavity was fully opened. A patch was used to cover the pseudoaneurysm
and was placed under the orifice of the left coronary artery.
This patch repair of the cavity was accomplished, followed by
prosthetic valve replacement in situ. Trivial PVL was identified
after the operation, and a diagnosis of intravascular mechanical
hemolysis was made. Clinical examination revealed partial detachment
of the prosthetic valve resulting in a significant PVL and paraannular
pseudoaneurysm. Because of unremitting hemolysis and the increased
PVL, the patient underwent a 4th repair. Inspection showed that
the prosthetic valve was partially detached and the defect was
opened at the upper edge. The orifice of the aneurysmal was covered,
and valve replacement was performed in the supraannular position
using 3 U-stays, which were passed through both the aortic wall
and the patch, followed by ascending aortic graft replacement.
In the case of aortic valve endocarditis with paraannular involvement,
radical debridement and complete reconstruction of the left ventriculoaortic
discontinuity without tension are required.
Jpn. J. Cardiovasc. Surg. 33: 182-184 (2004) |
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