A Case of Aortic Root Replacement and Patch Closure for Aorto-Right Ventricular Fistula Secondary to Infective Endocarditis

Hiroyuki Seo

Hiromichi Fujii

Takanobu Aoyama and Yoshikado Sasako

（Department of Cardiovascular Surgery, Osaka Koseinenkin Hospital, Osaka, Japan）

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●R 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.

　

Jpn. J. Cardiovasc. Surg. 43:118-123（2014）

Keywords：infective endocarditis;annular abscess;aorto-right ventricular fistula;aortic root replacement;patch closure