Aortic Root abscess repair in a patient with previous mechanical aortic valve replacement, mitral regurgitation and ischemic heart disease

Ahmed Ahmed Fouad Abdelwahab Ahmed


We present a complex case of aortic root abscess and fistula formation between the aorta and left ventricle, 20 years after aortic valve replacement with a mechanical prosthesis. The patient had concomitant severe rheumatic mitral valve regurgitation, significant left anterior descending and left circumflex coronary artery stenosis, with non-viable anterior wall and apex. In addition to replacing the mitral valve with a mechanical prosthesis, our decision was to treat the abscess and patch the fistula, while keeping the well functioning mechanical aortic valve to use its cuff to fix the patch. We have chosen to delay revascularization of the marginal branches with DES till after surgery to avoid extensive dissection under clopidogrel. We think that those decisions simplified the operative procedure and were essential to reach the positive outcome we had in this case.


Aortic root abscess, infective endocarditis and rheumatic heart disease.

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