Aortic root abscess is a recognized complication of both native and prosthetic valve endocarditis. It is uncommon to develop an aortic root abscess secondary to aortic root graft infection (in the absence of prosthetic valve endocarditis), and there is sparse literature on the management of these patients. We present a case of aortic root abscess where infection had arisen from an infected aortic valve graft replacement in a patient with Marfan’s syndrome.
Case Report
A 41-year-old patient with Marfan’s syndrome underwent prophylactic mechanical aortic valve, aortic root, and ascending aorta replacement (Bentall procedure) with coronary artery reimplantation for aortic root dilatation. One year later, he presented with chest pain, fever, and rigors. Methicillin-sensitive Staphylococcus aureus was isolated in all initial pre-antibiotic blood cultures and intravenous flucloxacillin was commenced.
Transthoracic echocardiography (TTE) demonstrated a well-seated prosthetic, mechanical aortic valve with no visible vegetations. Transesophageal echocardiography (TEE) and contrast-enhanced computed tomographic (CT) imaging showed a periaortic graft (and mediastinal) collection (Figure). Following percutaneous drainage and intensive antimicrobial therapy, the patient underwent surgical explantation of the aortic valve graft and implantation of a homograft. The patient made a good recovery and was discharged on long-term oral flucloxacillin.
Discussion
The Bentall procedure involves replacement of the aortic valve, root, and tubular ascending aorta with a Dacron graft. It can be performed prophylactically for patients with a dilated aortic root, for example, Marfan’s syndrome. There is a single reported case of aortic root graft abscess following a modified Bentall procedure, with reported abnormal TTE/TEE and a mediastinal fluid collection noted on CT.1 Overall, aortic root graft infection is an uncommon complication of aortic root repair surgery, particularly in the absence of prosthetic valve endocarditis.2
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-Eamon P. McCarron, MPhil, MRCP(UK), Glen Clarke, FRCR, Shiva Sreenivasan, FRCP (Edin), FRCP, Monica Monaghan, PhD FRCP (Edin)
This article originally appeared in the June 2019 issue of The American Journal of Medicine.
