Methodist Journal

IN THIS ISSUE

Venous Interventions

Vol 14, Issue 3 (2018)


FEATURED GUEST EDITOR

ISSUE INTRO

It’s Time We Reassess Our Primitive Understanding of the Venous System

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RECOGNITIONS

Jean Bismuth Spearheads Issue on Venous Interventions

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REVIEW ARTICLES See More

Central Venous Pathologies: Treatments and Economic Impact

Venous Thrombosis and Post-Thrombotic Syndrome: From Novel Biomarkers to Biology

Mechanical Properties of Diseased Veins

Use of Computed Tomography and Magnetic Resonance Imaging in Central Venous Disease

Application of Intravascular Ultrasound in End-Stage Renal Patients with Central Venous Occlusive Disease

Intraoperative Imaging and Image Fusion for Venous Interventions

Endovascular Treatment for Venous Diseases: Where are the Venous Stents?

Endovascular Therapy for Central Venous Thrombosis

CASE REPORTS See More

Immune Checkpoint Inhibitor Related Cardiotoxicity

Tyrosine Kinase Inhibitor-Induced Acute Myocarditis, Myositis, and Cardiogenic Shock

Primary Nonbacterial Thrombotic Endocarditis Presenting with Bowel Infarction Secondary to Superior Mesenteric Artery Embolism

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Incision and Drainage of a Forgotten Vascular Graft

CLINICAL PERSPECTIVES See More

EXCERPTA

Telemedicine Shakes Up the ICU Experience

POINTS TO REMEMBER

Venous Thrombosis in Nephrotic Syndrome

EXCERPTA

Heartsick: Medical and Ethical Challenges of Infective Endocarditis in the Opioid Epidemic

EXCERPTA

Redefining “Worth It” for CTO PCI

EDITORIALS

Letter to the Editor

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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