title: Endocarditis with left ventricular cutaneous fistula after aortic root replacement with a valved conduit.
abstract: Infection after aortic root replacement is uncommon, and it can be fatal. Herein, we present the case of a patient who underwent aortic root replacement with a valved conduit and coronary reimplantation. Prosthetic valve endocarditis and left ventricular cutaneous fistula ensued. Either condition alone could have been fatal. The fistula coursed from the valved conduit through the left ventricular outflow tract, behind the left main coronary artery, and to the skin at the upper sternum. Safe surgical entry into the chest was crucial, due to the free communication between the left ventricle, mediastinum, and skin. We discuss our surgical approach to this unusual combination of conditions, and the postoperative treatment of the patient.
authors.affiliation: Department of Cardiac Surgery, The Methodist Hospital, Houston, Texas 77030, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Hollinger
authors.forename: Lynda
authors.initials: L
authors.lastname: Perryman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reardon
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D012086:Reoperation; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
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