Aortic endocarditis complicated with a large ventricular septal defect and septic pulmonary embolism.
BACKGROUND
Infectious complications of the aortic valve can lead to severe cardiac failure and widespread contiguous lesions by the involvement of subaortic structures such as aorto-left ventricular discontinuity, destruction of the aortic ring, aortic abscesses, true or false aneurysms and shunts.


OBJECTIVE
Report a new case of a large ventricular septal defect due to infection.


METHODS
Abnormal communications occurring during acute aortic valve endocarditis are rare but they are very serious complications. We report a case of a 58 year-old-man, referred to our hospital with the diagnosis of aortic endocarditis with complicating root abscesses, acquired ventricular septal defect (VSD) and pulmonary septic embolism. Surgery was indicated and the whole procedure was performed through the aortic root. The patient underwent a radical resection of the abscesses, reconstruction of the aortic ring, closure of the ventricular septal defect and prosthetic replacement of the aortic valve. The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse.


CONCLUSIONS
The authors would like to select and analyze some weaknesses of their procedure like using only the transaortic access that often limits exposure of possible right-side lesions, not removing the pulmonary obstruction and using an important amount of foreign material to reconstruct subvalvular lesions.
Department of Cardiovascular Surgery, Military Hospital, 1008 Montfleury, Tunis, Tunisia.
Hatem
H
Lahdhili
Walid
W
Ghodbane
Mohamed
M
Ziadi
Mohamed
M
Shili
Slim
S
Chenik
D004697:Endocarditis, Bacterial / Q000150:complications*; D017809:Fatal Outcome; D006345:Heart Septal Defects, Ventricular / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000382:microbiology; D018805:Sepsis / Q000150:complications*; D013203:Staphylococcal Infections / Q000150:complications