Discussion
At present, surgical management of aortic valve endocarditis is based on
the use of conventional stented mechanical,
bioprostheses1,3, or when possible, stentless
bioprostheses4.
In this case, the choice of this prosthesis was related to the poor
quality of the aortic annulus. The reconstruction with the pericardial
patch started deep within the interventricular septum and then covered
and anchored the anterior mitral valve leaflet to the aortic wall. This
was because of a gap generated by the deficiency of the deteriorated
annulus. For this reason, we preferred not to use sutures with pledgets
to pass in the area recently reconstructed with the patch, but instead
we preferred to exclude this area using a rapid deployment
bioprosthesis.
The subvalvular skirt of Intuity stabilized the prosthesis to the aortic
annulus and excluded our reconstructed zone from the left ventricular
outflow, with the aim of reducing the chance of interventricular defect
reopening due to the left ventricle outflow blood jet. Additionally, the
radial force could transmit solidity to the surrounding tissues and
ensure more stability to the reconstructed structures
Finally, soon after the heart was reperfused, and an AV complete block
was evident, we preferred to implant two definitive epicardial leads
(atrial and ventricular) convenient for A-V pacing, avoiding
intravascular leads that have more chances to complicate new cases of
endocarditis in presence of positive blood cultures.
The patient continued the antibiotic therapy for 6 weeks following
surgery. She was screened again after 6 months and she did not show any
recurrences of endocarditis, prosthetic dysfunctions, or intracardiac
shunts.