Non-bacterial thrombotic endocarditis in an adult 14 months after cryopreserved aortic allograft valve implantation.
Cryopreserved aortic allograft tissue is used to correct aortic valve disease in adults and to reconstruct the right ventricular outflow tract in children with congenital heart disease. In adults, allograft durability is regarded as comparable to or better than that of manufactured bioprostheses, with failure usually due to slow fibrocalcific degeneration. Normally, allograft semilunar valves have excellent hemodynamics and low rates of infectious endocarditis and thromboembolism. The role of immune-mediated inflammation in post-implant allograft valve performance is slow in onset, and variable. Herein is presented the case of a male adult with rapid deterioration of the aortic valve homograft wall, without loss of the valve leaflets, resulting in severe aortic regurgitation. The pathological findings were consistent with classical marantic (sterile) endocarditis with acute and chronic inflammatory changes associated with advanced atherosclerotic lesions in the allograft aortic wall tissue resulting in thrombosis and subsequent cerebral embolization.
Forman
Mervyn B
MB
Emory University, Atlanta, GA, USA.
Atkinson
James B
JB
Wolfe
J Alan
JA
Hopkins
Richard A
RA
D000328:Adult; D001011:Aorta / Q000002:abnormalities / Q000637:transplantation*; D050197:Atherosclerosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D003328:Coronary Thrombosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D015925:Cryopreservation; D004696:Endocarditis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013997:Time Factors