Sažetak sa skupa

https://doi.org/10.15836/ccar2019.78

The role of multimodality imaging in clinical decision-making of the heart team in complex aortic root reconstruction due to endocarditis

Dubravka Šušnjar orcid.org/0000-0002-9644-9739 ; University Hospital Dubrava Zagreb, Croatia
Sandra Jakšić Jurinjak ; University Hospital Dubrava Zagreb, Croatia
Boris Starčević ; University Hospital Dubrava Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
Josip Varvodić ; University Hospital Dubrava Zagreb, Croatia
Davor Barić ; University Hospital Dubrava Zagreb, Croatia
Daniel Unić ; University Hospital Dubrava Zagreb, Croatia
Robert Blažeković ; University Hospital Dubrava Zagreb, Croatia
Igor Rudež ; University Hospital Dubrava Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia

Sažetak

Case report: 29-year-old m ale u nderwent aortic root reconstruction w ith root remodeling technique and external ring annuloplasty (Corneo Extra Aortic Ring A 29, Gelweave graft 30 mm) in 2015 due to bicuspid aortic valve with significant aortic regurgitation and aortic root dilatation. In 2017 due to pseudoaneurysm of aortic root and severe aortic regurgitation, the patient was reoperated and mechanical
aortic valve was implanted (Carbomedics Mechanical A 25) with patch plastic of the pseudoaneurysm. A year later he was admitted again, now due to fever and high inflammatory markers. Multimodality imaging, transthoracic echocardiography, transesophageal echocardiography, MSCT aortography and abdominal CT described aortic /perivalvular root abscess with significant paravalvular leak in terms of hemodynamically significant regurgitation with high flow velocity over the mechanical valve, peak velocity > 4 m/s. TEE (2D+3D) showed the septate hyperechogenic formation with hypoechogenic cavities which seemed to touch a part of trigonum, approximately 15 mm thick, extending from annulus ascending to the entire visible part of the aortic root, ascending more than 4 cm. It appeared to affect > 50% of the annulus, with visible paraannular leak and massive aortic regurgitation. Previously implanted patch plastic on aortic root was hypermobile depending on heart cycle. Left ventricle showed normal contractility. MSCT of thorax and aortography confirmed the finding (Figure 1). The patient was diagnosed with endocarditis of the mechanical aortic valve and aortic root abscess, thus the antimicrobial therapy was started. Patient had to undergo urgent surgical reoperation. Aortic root replacement with coronary artery reimplantation was performed (sec Bentall, BioIntegral Surgical A 23). There were no signs of paravalvular leak on the control MSCT aortography, with proper flow through graft, coronary artery and supra-aortal branches. Control echocardiography showed a good function of the mechanical valve. Patient recovered successfully and was sent home after antimicrobial therapy protocol was finished.
Conclusion: Cooperation of the heart team (cardiologist, heart surgeon, radiologist) and multimodality imaging is a paramount for accurate
diagnosis and management of patients with complex aortic pathology1,2.

Ključne riječi

aortic root reconstruction; aortic valve insufficiency; endocarditis

Hrčak ID:

220606

URI

https://hrcak.srce.hr/220606

Datum izdavanja:

31.5.2019.

Posjeta: 765 *