Uchida Tetsuro, Kuroda Yoshinori, Kobayashi Kimihiro, Sadahiro Mitsuaki
Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.
Interact Cardiovasc Thorac Surg. 2020 Mar 1;30(3):439-442. doi: 10.1093/icvts/ivz284.
An extensive infection of the native aortic or prosthetic valve beyond the aortic annulus could be complicated with various types and degrees of tissue destruction. The left ventricular-aortic discontinuity resulting from extensive infective endocarditis often necessitates pericardial reconstruction of the left ventricular outflow tract and subsequent aortic root replacement. Furthermore, if the membranous ventricular septum is involved with infective tissue destruction, communication between the left ventricle and right atrium, known as a Gerbode defect, and complete atrioventricular block could occur. Surgical reconstruction of these complex pathologies is challenging, with high mortality and morbidity. Herein, we present a rare case of prosthetic valve endocarditis complicated with both left ventricular-aortic discontinuity and an acquired Gerbode defect. At the time of surgery, left ventricular outflow tract reconstruction and the technically more demanding aortic root replacement were considered inevitable because of extensive tissue destruction. However, we performed circumferential left ventricular outflow tract reconstruction with a xenopericardial patch and supra-annular aortic valve replacement using the Solo Smart bovine pericardial stentless valve as a technically less demanding alternative to aortic root replacement. The postoperative course was uneventful, and the patient is well 1 year postoperatively, without valvular dysfunction and recurrent infection.
天然主动脉瓣或人工瓣膜的广泛感染超出主动脉瓣环，可能会并发各种类型和程度的组织破坏。广泛感染性心内膜炎导致的左心室 - 主动脉连续性中断，往往需要对左心室流出道进行心包重建，随后进行主动脉根部置换。此外，如果膜性室间隔受到感染性组织破坏，可能会出现左心室与右心房之间的交通，即Gerbode缺损，以及完全性房室传导阻滞。这些复杂病变的外科重建具有挑战性，死亡率和发病率都很高。在此，我们报告一例罕见的人工瓣膜心内膜炎病例，该病例同时并发左心室 - 主动脉连续性中断和后天性Gerbode缺损。手术时，由于广泛的组织破坏，左心室流出道重建以及技术要求更高的主动脉根部置换被认为是不可避免的。然而，我们使用异种心包补片进行了环周左心室流出道重建，并使用Solo Smart牛心包无支架瓣膜进行了瓣环上主动脉瓣置换，作为主动脉根部置换技术要求较低的替代方法。术后过程顺利，患者术后1年情况良好，无瓣膜功能障碍和反复感染。
