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Endocarditis with massive aortic root abscess and atrioventricular septal destruction

Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, 3400 Spruce Street, 6 Silverstein Pavilion, Philadelphia, PA 19104, USA

*Corresponding author. Tel.: +1 (215) 662-2956; fax: +1 (215) 349-5798.

E-mail address: wooy{at}uphs.upenn.edu (Y.J. Woo).

Endocarditis involving the aortic root and intervalvular fibrous skeleton presents a reconstructive dilemma. We report a case of endocarditis involving the aortic root and tricuspid valve with extensive destruction of the atrioventricular septum. Debridement necessitated resection of the aortic root, aortic valve, tricuspid valve, and a large portion of atrioventricular septum, leaving the right atrium, right ventricle, left ventricle and aorta in open communication. Reconstruction was accomplished by separating the left and right hearts with a Dacron patch, tricuspid valve replacement, and aortic root replacement. Proper planar localization of the aortic root was necessary to avoid left ventricular outflow obstruction and coronary torsion.

Key Words: Endocarditis; Aortic root; Tricuspid valve