A case of prosthetic valve endocarditis successfully treated by translocation of the aortic valve
Shimizu, T.; Iriyama, T.; Aida, H.; Sakamoto, S.; Iwanami, H.; Nakajima, M.
Nihon Kyobu Geka Gakkai 33(12): 2239-2244
1985
ISSN/ISBN: 0369-4739 PMID: 3879493 Document Number: 258426
The patient who underwent aortic valve replacement for the treatment of infected endocarditis had recurrent prosthetic valve endocarditis with perivalvular leakage at two months following the initial operation. Translocation of the aortic valve and aorto-coronary bypass with the use of saphenous vein grafts was successfully accomplished in the treatment of this patient. The thirty-nine year old man had had a high erythrocyte sedimentation rate, positive CRP, and aortic regurgitation (Sellers III.degree.). In October, 1983, aortic valve replacement was performed with a St. Jude Medical heart valve (# 21). Vegetation and abscess were noted on the aortic wall and valve ring. Microorganisms were not proven microscopically or by tissue culture. Fifty days postoperatively, a diastolic murmur became audible on the 3rd LSB and heart failure developed. On the 23rd of December, 1983, an emergency reoperation was carried out. Vegetation and abscess were located on the valve ring and the proximate aortic wall. Valve dehiscence was noted on one third of the circumference of the valve ring. St. Jude Medical mitral valve (# 27) was sutured upside down in the ascending aorta 2 cm away from the valve ring after removing the infected prothesis and debridement. Each distal anastomosis of saphenous vein grafts was performed on the both segment 2 of right coronary artery and segment 6 of the left anterior descending artery. The proximal anastomosis was cranial to the reimplanted valve of ascending aorta. Bilateral native coronary arterial orifices were closed by sutures. Although intraaortic balloon pump was used postoperatively, the patient recovered gradually and one year after the surgery spends normal daily life. A pathological report of aortic wall and vegetation of the valve ring was suggestive of aortitis syndrome.