Aortic root pseudoaneurysm following surgery for aortic valve endocarditis.

Prosthetic aortic valve replacement for aortic valve endocarditis remains a primary practice of most cardiac surgeons. Usually it cures endocarditis and restores cardiac function. However, in advanced aortic valve endocarditis with complex annular destruction, complications following prosthetic aortic valve replacement do occur and present a formidable challenge for reoperation. Herein, we describe a case of an adult man who was operated on initially for advanced aortic valve endocarditis with a large periannular abscess cavity and who developed congestive heart failure 3 months later. Furthermore, he was diagnosed with a giant pseudoaneurysm around the aortic root without evidence of recurrent infection or aortic prosthetic incompetence. During his reoperation, a cryopreserved aortic homograft as a root replacement that included reimplantation of bilateral coronary artery buttons was used to exteriorize this pseudoaneurysm and reconstruct a left ventricular outflow tract. The postoperative course was unremarkable, and the patient, during a follow-up of 2 years, remained in New York Heart Association functional class I. Aortic root pseudoaneurysm following prosthetic aortic valve replacement for infective endocarditis is rare in clinical practice and can cause rapid hemodynamic deterioration which requires imminent reoperation. Homograft aortic root replacement has proven to be a versatile treatment option of this complex disease.