Periannular left ventricular aneurysm following aortic valve replacement for acute aortic insufficiency due to bacterial endocarditis: enlargement of left ventricular outflow tract obstruction induced by closure of annular erosion and periannular aneurysm
Hiekata, T.; Kawada, T.; Okada, T.; Osada, H.; Noguchi, T.
Nihon Kyobu Geka Gakkai 28(9): 1441-1447
1980
ISSN/ISBN: 0369-4739 PMID: 7430726 Document Number: 157995
A 55 yr old female was admitted to a hospital because of recurrence of bacterial endocarditis 1 yr after aortic valve replacement (21 mm Carpentier-Edwards xenograft bioprosthesis) performed for acute aortic insufficiency due to bacterial endocarditis. At 17 days after the recurrence of high fever, a faint diastolic murmur developed at the 3rd left intercostal space parasternally which rapidly increased in intensity with concomitant increase in hepatomegaly and cardiomegaly requiring urgent re-exploration. At operation the xenograft bioprosthesis was almost detached and the annular area was deeply eroded around the entire circumference of the annulus. The ventricular septum was deeply eroded at the annular region of the left coronary cusp extending toward the outflow tract of the right ventricle and a false aneurysm was recognized which had developed at the mitral-aortic intervalvular fibrosa protruding between the aorta and the left atrial wall. These annular cavities and the aneurysm were closed using pledget sutures. The procedure caused obstruction of the left ventricular outflow tract. Aortotomy was then extended down to the aortic annulus in the noncoronary sinus and further incision was made through the annulus down to the central portion of the anterior mitral leaflet and into the left atrial wall simultaneously. A patch was inserted into the incision made in the anterior mitral leaflet, annulus and left atrial wall, providing adequate enlargement of the left ventricular outflow tract to anchoring 19 mm Bjork-Shiley prosthetic valve. A Dacron graft was used to close the aortotomy incision. The patient could not be weaned from cardiopulmonary bypass. The peculiar morphological changes induced by bacterial infection and the method for the enlargement of left ventricular outflow tract obstruction were described.