Abstract
Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords “aortic root mycotic aneurysm,” “aortic root abscess AND infective endocarditis,” and “aortic root mycotic aneurysm AND infective endocarditis” yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, n = 127). Mean age is 51 years (4 months–84 years). The most common symptom is fever (68.5%, n = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% (n = 28) at diagnosis. Most cases are due to valvular infections (n = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% (n = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% (n = 35) are immunocompromised. Aetiological agents were Staphylococcus sp. (34.1%, n = 47) and Streptococcus sp. (23.2%, n = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% (n = 27); with surgery 12.2% (n = 15 out of 123 patients), with only medical management 47.8% (n = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option.
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References
Lambert V, Paul JF, Belli E, Serraf A. Aortic root abscess with coronary artery involvement: diagnostic and surgical management. Pediatr Cardiol. 2008;29:653–5.
Scullion MMF, Lynn P, Marshall A, MacDougall D. Aortic valve endocarditis with root abscess causing superior vena cava obstruction: a case report. Eur Heart J Case Rep. 2019;3:1–6.
Enoch DA, Phillimore N, Karas JA, Horswill L, Mlangeni DA. Relapse of enterococcal prosthetic valve endocarditis with aortic root abscess following treatment with daptomycin in a patient not fit for surgery. J Med Microbiol. 2010;59:482–5.
Tleyjeh IM, Abdulhak AAB. ESC CardioMed. Epidemiology and global burden of infective endocarditis: Oxford University Press; 2018.
Kirali K, Sarikaya S, Ozen Y, Sacli H, Basaran E, Yerlikhan OA, et al. Surgery for aortic root abscess: a 15-year experience. Tex Heart Inst J. 2016;43:20–8.
Patel M, Nesheiwat Z, Patel N, Soni RG, Maaieh M. Triple valve endocarditis with aortic root abscess presenting with complete heart block and distal embolization. Cureus. 2021;13: e13942.
Khan MZ, Franklin S, Zahid S, Kutalek S, Kilcoyne J. Shock secondary to aortic root abscess with sterile blood culture. Cureus. 2021;13: e15262.
Lobo R, Meany B, O’Hanlon R, Kiernan TJ. Fever of unknown origin, with a twist. BMJ Case Rep. 2013;2013:bcr2012008074.
Morimoto N, Nishioka N, Yoshida M, Mukohara N. Rapid expansion of mycotic aneurysm of left coronary sinus of Valsalva causing myocardial ischemia: report of a case. Gen Thorac Cardiovasc Surg. 2016;64:160–2.
Nappi F, Spadaccio C, Mihos C. Infective endocarditis in the 21st century. Ann Transl Med. 2020;8:1620.
Sunil M, Hieu HQ, Arjan Singh RS, Ponnampalavanar S, Siew KSW, Loch A. Evolving trends in infective endocarditis in a developing country: a consequence of medical progress? Ann Clin Microbiol Antimicrob. 2019;18:43.
Benedetto U, Avtaar Singh SS, Spadaccio C, Moon MR, Nappi F. A narrative review of the interpretation of guidelines for the treatment of infective endocarditis. Ann Transl Med. 2020;8:1623.
Preventza O, Mohamed AS, Cooley DA, Rodriguez V, Bakaeen FG, Cornwell LD, et al. Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis: a 12-year experience in high-risk patients. J Thorac Cardiovasc Surg. 2014;148:989–94.
Kreibich M, Siepe M, Berger T, Pingpoh C, Puiu P, Morlock J, et al. Treatment of infectious aortic disease with bovine pericardial tube grafts. Eur J Cardiothorac Surg. 2021;60:155–61.
Mahrouf A, Soulat G, Lebeaux D, Iserin L, Karsenty C. Cactus aorta. Eur Heart J. 2017;38:3325–6.
Gunay I, Mert M, Kucukoglu S, Ozkan AA, Okcun B. Successful repair of a large aortic abscess causing apical displacement of the anterior mitral valve. Heart Vessels. 2005;20:33–6.
David TE, Armstrong S, Maganti M, Colman J, Bradley TJ. Long-term results of aortic valve-sparing operations in patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2009;138:859–64.
Bach DS, Kon ND. Long-term clinical outcomes 15 years after aortic valve replacement with the Freestyle stentless aortic bioprosthesis. Ann Thorac Surg. 2014;97:544–51.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2017;70:252–89.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.
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Alexander Loch and Pravinthiran Manokaran contributed to the conception of the article. Literature search and data analysis were performed by Pravinthiran Manokaran, Sivakumar Krishnasamy, Raja Rizal Azman bin Raja Aman, and Victoria Wen Yeng Teoh. The first draft of the manuscript was written by Pravinthiran Manokaran and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Manokaran, P., Krishnasamy, S., Aman, R.R.A.b.R. et al. Aortic root pseudoaneurysm: a case report and literature review. Indian J Thorac Cardiovasc Surg 40, 68–77 (2024). https://doi.org/10.1007/s12055-023-01580-x
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DOI: https://doi.org/10.1007/s12055-023-01580-x