Journal of Acute Care

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VOLUME 2 , ISSUE 3 ( September-December, 2023 ) > List of Articles


A Salvage Procedure in a High-risk Case of Prosthetic Valve Endocarditis with Aortic Root Abscess and Valve Dehiscence: A Case Report

Pooja Natarajan, Mahesh Prabhu

Keywords : Aortic root abscess, Case report, Life-threatening, Prosthetic valve endocarditis

Citation Information : Natarajan P, Prabhu M. A Salvage Procedure in a High-risk Case of Prosthetic Valve Endocarditis with Aortic Root Abscess and Valve Dehiscence: A Case Report. 2023; 2 (3):158-160.

DOI: 10.5005/jp-journals-10089-0086

License: CC BY-NC 4.0

Published Online: 19-02-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Aortic root abscess in prosthetic valve endocarditis (PVE) can be a life-threatening situation, especially when associated with dehiscence of the aortic annulus, which is reported in 0.1–1.3% of patients who undergo aortic valve replacement (AVR). Early diagnosis and timely intervention could aid in a positive outcome, even in a deteriorating patient. The “endocarditis team” approach is very beneficial, especially in early diagnosis and surgical therapy. Case description: A 70-year-old gentleman who was awaiting homograft aortic root replacement (ARR) was presented with a sudden onset of respiratory distress requiring emergency intubation, ventilation, and high doses of inotropes/vasoconstrictors. He had previously undergone tissue AVR, 5 months earlier, along with coronary artery bypass grafting. On examination, he was in a low cardiac output state, which correlated with his echo findings of severe biventricular dysfunction, aortic root abscess, loss of aorto-mitral continuity, severe periprosthetic valve regurgitation, and tricuspid valve vegetation. Hence, he was diagnosed with infective endocarditis (IE) complicated with PVE. After a detailed discussion with relatives about the high risk of mortality and morbidity, he underwent an emergency salvage homograft ARR surgery and was discharged from the hospital on day 12. Conclusion: Although we come across many patients with PVE, management of emergency situations with dehiscence of the aortic annulus with root abscess can be a serious situation to tackle, and good teamwork with timely decisions taken will facilitate a good outcome. Clinical significance: Echocardiography helps in the early diagnosis of IE and surgical decision-making for a salvage procedure in case of PVE with intracardiac abscess and dehiscence of aortic annulus.

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