title: Fortune or misfortune: asymptomatic, delayed presentation of complete dehiscence of mechanical aortic valve conduit and pseudoaneurysm.
abstract: Complete dehiscence of a composite aortic valve graft with pseudoaneurysm formation is a rare complication following aortic root replacement. This complication often takes place in the setting of acute graft infection and accompanies symptoms of heart failure, valve insufficiency or sepsis. We present a delayed, asymptomatic presentation of this complication in a young man with distant history of aortic root replacement and medically treated prosthetic valve endocarditis a year postoperatively. He had been non-adherent to warfarin over 10 years, but otherwise maintained a healthy life. After being lost to follow-up, he re-presented 12 years after the initial operation with new-onset seizures. Echocardiogram revealed complete dehiscence of a composite valved conduit at the proximal anastomosis site with a resultant large pseudoaneurysm. The patient underwent an urgent re-operation with resection of the pseudoaneurysm and insertion of a tissue valved conduit. He had an uncomplicated postoperative recovery and promised close follow-up on discharge.
authors.affiliation: Montefiore Hospital and Medical Center, Bronx, New York, USA.
authors.forename: Kyung Taek
authors.initials: KT
authors.lastname: Oh
authors.affiliation: Montefiore Hospital and Medical Center, Bronx, New York, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Derose
authors.affiliation: Montefiore Hospital and Medical Center, Bronx, New York, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Taub
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000209:etiology; D057210:Delayed Diagnosis; D004696:Endocarditis / Q000188:drug therapy; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D011475:Prosthesis Failure / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000188:drug therapy; D012086:Reoperation; D016896:Treatment Outcome