Methodist Journal

IN THIS ISSUE

Adult Congenital Heart Update

Vol 15, Issue 2 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Growing Number of Adults Surviving with Congenital Heart Disease

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RECOGNITIONS

Drs. MacGillivray and Lin Take the Lead in Adult Congenital Heart Disease

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REVIEW ARTICLES See More

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

149 Fontan Conversions

Anomalous Aortic Origin of a Coronary Artery

Pulmonary Valve Replacement for Tetralogy of Fallot

Management of the Adult with Arterial Switch

Ebstein’s Anomaly

Heart Transplantation in Adults with Congenital Heart Disease

Cholesterol: Can’t Live With It, Can’t Live Without It

CASE REPORTS See More

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 14, Issue 2 (2018)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

A Giant Aortic Root Abscess

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Article Citation:

Al Emam AR, Moulton M, Hyden M, Chatzizisis Y. A Giant Aortic Root Abscess. Methodist DeBakey Cardiovasc J. 2018;14(2):150.

doi: 10.14797/mdcj-14-2-150

Keywords
aortic root abscess , aortic stenosis , transesophageal echocardiography , TEE , computed tomography , CT , prosthetic valve

A 63-year-old male with a history of coronary artery disease and severe aortic stenosis status post mechanical aortic valve replacement and coronary artery bypass presented with atypical chest pain and group B streptococcal bacteremia. His transesophageal echo (TEE) was read as negative for vegetations, and chest computed tomography (CT) was reportedly unremarkable. He was started on antibiotics, and coronary angiography showed severe triple-vessel disease, patent left internal mammary artery graft, and complete occlusion in all vein grafts. Percutaneous intervention with stenting of the left anterior descending and circumflex artery was performed. During the diagnostic angiography, nonselective contrast injection showed an anterior aortic root “pouch” (A, Video 1), but since the CT was unremarkable, no further investigation was done. A month later, the patient presented with fatigue and persistent bacteremia. TEE showed a large circumferential hypoechoic space with radial strands around the sewing ring of the mechanical valve (B) along with new moderate perivalvular leak (C). A CT scan showed extensive perivalvular and para-aortic contrast collections extending from below the aortic annulus to mid-ascending aorta, consistent with abscesses/pseudoaneurysms (D, E). Both right and left coronary arteries were coursing through these abscesses/pseudoaneurysms (E). The mechanical valve was sitting on the abscesses and appeared to be dehiscent (D). Retrospective review of the initial TEE (F) and CT (G) showed evidence of aortic root infection (arrows). The patient underwent aortic root repair and aortic valve replacement. An aortic root pathology specimen showed fibrous growth with calcification and focal acute and chronic inflammation. After a complicated hospital course, the patient was discharged to a rehabilitation facility. Meticulous evaluation with imaging and high index of suspicion is necessary when there is a question about infection in patients with prosthetic valves.

Conflict of Interest Disclosure

Dr. Al Emam is a consultant for Medicure International, Inc.

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