Surgery for aortic valve endocarditis: treatment options for aortic abscess.
BACKGROUND
Patients with infective endocarditis show a large diversity of anatomical presentations, which has been a complicating factor for the surgical treatment of this condition, especially in those who develop abscesses in the aortic ring or intracardiac fistulae. For this reason, surgeons have been developing tactical options to repair it. There is consensus around the fact that the removal of infected tissue promotes radical cleaning, and that the outcome of the treatment has been improved by the manufacture of biological glues which facilitate the closure of abscesses and by the creation of new valve replacements.


OBJECTIVE
To demonstrate yet one more treatment option for aortic abscess for selected cases: a valved conduit placed in infra-coronary position.


METHODS
We employed the technique in three patients: in two of them we employed a valved conduit with a mechanical prosthesis and in one of them a valved conduit with a biological prosthesis. Two patients needed associated procedures such as replacement of mitral valve in one of them and tricuspid valvoplasty in the other. All cases involved reoperation of prostheses in aortic position.


RESULTS
The progression during surgery and in the early postoperative period was satisfactory and the three patients were discharged from the Intensive Care Unit and were sent to hospital rooms. One of the patients progressed to death during hospital stay due to severe comorbidities which were present in the preoperative period, and which related to esophageal varices and hepatic involvement. The other two progressed well in the late postoperative period.


CONCLUSIONS
We believe that this option is yet one more alternative for the treatment of abscesses with great involvement of aortic ring structures and mitro-aortic continuity.
Arnoni
Antoninho Sanfins
AS
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil. aarnoni@hpev.com.br
Arnoni
Renato Tambellini
RT
Paulista
Paulo Paredes
PP
Martinez
Victoria E
VE
Almeida
Antonio Flavio Sanches
AF
Abdulmassih Neto
Camilo
C
Dinkhuysen
Jarbas Jackson
JJ
Issa
Mario
M
Chaccur
Paulo
P
Souza
Luiz Carlos Bento de
LC
D000038:Abscess / Q000601:surgery*; D000328:Adult; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000601:surgery*; D006349:Heart Valve Diseases / Q000382:microbiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome