Infectious endocarditis course after ascending aorta replacement with a valved conduit
https://doi.org/10.20514/2226-6704-2019-9-6-450-459
Abstract
Objective. To demonstrate the peculiarities of infectious endocarditis course in patients after ascending aorta replacement using a valved conduit based on the personal observations.
Material and methods. Six cases of delayed infectious endocarditis after ascending aorta replacement using a valved conduit are presented.
Results. The pathological process was represented by aortic root abscess, paraprosthetic phlegmon, fistula penetrated into the conduit wall and cardiac chambers. There was no vegetation on the prosthesis therefore the diagnosis was complicated. Period from fever onset to final diagnosis lasted from 1 week to 2.5 months. The first pathologic changes in all cases were detected using transesophageal echocardiography, but this method was not informative in the early stages of the disease.
Conclusion. Infectious endocarditis in patients after ascending aorta replacement using a valved conduit has its own peculiarities. The most frequently, the process leads to the development of aortic root abscess. Diagnosis of infectious endocarditis in such cases is difficult. Infectious endocarditis should be suspected in patients - carriers of valved conduit with unexplained fever and treatment should be started in accordance with the diagnosis. In this case, structural changes visualization to confirm the disease is not necessary.
About the Authors
N. A. Morova
Omsk State Medical University
Russian Federation
Competing Interests: not
Russian Federation
Natalia A. Morova
Competing Interests: not
V. N. Tsekhanovich
The Regional clinic hospital; Omsk State Medical University
Russian Federation
Competing Interests: not
Russian Federation
Competing Interests: not
References
1. I. Olsson C., Thelin S., Stable E. et al. Thoracic aortic aneurysm and dissection: Increasin prevalence and improved outcomes reported in a nationwide populationbased study of more than 14,000 cases from 1987 to 2002. Circulation, 2006; 114:2611-8.
2. Kokoev M.B., Mironenko V.A., Rychin S.V. et al. Features of repeated operations using a cryopreserved allograft and synthetic conduit for prosthetic endocarditis with aortic root destruction. Byulleten' NTSSSKH im. A.N. Bakuleva RAMN «Serdechno-sosudistyye zabolevaniya».2016; 17(S3): 30. [In Russian].
3. Kokoev M.B., Mironenko V.A., Rychin S.V. et al. Repeated interventions on the ascending aorta and the arch. Modern aspects. Byulleten' NTSSSKH im. A.N. Bakuleva RAMN «Serdechno-sosudistyye zabolevaniya». 2017; 18(S3): 23. [In Russian].
4. Mironenko V.A., Rychin S.V., Kokoev M.B. et al. Use of cryopreserved allograft in reoperations in cases of extended aortic root infection, mediastinitis and prosthetic endocarditis. Grudnaya i serdechno-sosudistaya khirurgiya. 2017;6(59):375-85. doi: 10.24022/0236-2791-2017-59-6-375385. [In Russian]
5. Kaleda V.I., Boldyrev S.Yu., Barbukhatti K.O. Professor Hugh Bentall (1920—2012) and his operation for replacement of the ascending aorta (50th anniversary of Bentall procedure). Patologiya krovoobrashcheniya i kardiokhirurgiya 2016;20(2):120-6. doi:610.21688-1681-3472-2016-2-120-126. [ In Russian]
6. Malashenkov A.I., Rusanov N.I., Tereshchenko V.I. et al. Long-term results of xenopericardial conduit implantation during surgical correction of ascending aortic aneurysms. Byulleten' NTSSSKH im. A.N. Bakuleva RAMN «Serdechno-sosudistyye zabolevaniya». 2009; 10(S3): 23. [In Russian].
7. Ramos A., Garcia-Montero C., Moreno A. et al. Endocarditis in patients with ascending aortic prosthetic graft: a case series from a national multicentre registry. European Journal of Cardio-Thoracic Surgery. 2016;50(6):1149-57. doi.org/10.1093/ejcts/ezw190.
8. Monsefi N., Zierer A., Risteski P. et al. Long-term results of aortic valve resuspension in patients with aortic valve insufficiency and aortic root aneurysm. Interactive Cardiovascular and Thoracic Surgery. 2014;18(4):432-37. doi.org/10.1093/icvts/ivt530.
9. Kobayashi A., Nakazato K., Jin Y. et al. The ascending aorta pseudoaneurysm with myocardium rupture complicated with prosthetic valve infective endocarditis after aortic valve replacement. JGPR. 2014; 2: 155. doi:10.4172/2329-9126.1000155.
Review
For citations:
Morova N.A., Tsekhanovich V.N. Infectious endocarditis course after ascending aorta replacement with a valved conduit. The Russian Archives of Internal Medicine. 2019;9(6):450-459. https://doi.org/10.20514/2226-6704-2019-9-6-450-459
Views:
994
Email this article 