[Aorto-left ventricular discontinuity of infectious origin. Problems of surgical repair].

Aorto-left ventricular discontinuity may result from destruction of the aortic ring in aortic valve endocarditis, making solid implantation of a valvular prosthesis difficult. We believe the best technique to be the insertion of a valved Dacron tube from a noninfected area of the left ventricle to the ascending aorta distal to the coronary ostia, the coronary arteries being reimplanted in the tube. This technique implies a relatively dilated aortic ring and the integrity of the supra-annular aortic wall. When these conditions are not fulfilled, the problem has to be solved by supra coronary implantation of an aortic prosthesis with double aorto-coronary bypass grafts. Valved tubes from the left ventricular apex to the abdominal aorta is complex major surgery, the indications for which should be limited to the most mutilating forms of endocarditis causing such severe annular and periannular lesions that the two preceding techniques are impossible. Despite the advances in surgical technique, operative mortality remains high, a problem that could undoubtedly be reduced by early surgery before the association of hemodynamic and infectious complications lead to severe cardiac failure and widespread local lesions.