Methodist Journal

IN THIS ISSUE

Diabetes and the Heart

Vol 14, Issue 4 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Intersection of Diabetes and Cardiovascular Disease

See More
RECOGNITIONS

Guest Editors Steven Petak and Archana Sadhu Guide Issue on Diabetes and the Heart

See More

REVIEW ARTICLES See More

Cardiac Autonomic Neuropathy in Diabetes Mellitus

Stage-Based Management of Type 2 Diabetes Mellitus with Heart Failure

Imaging to Stratify Coronary Artery Disease Risk in Asymptomatic Patients with Diabetes

Update on Management of Type 2 Diabetes for Cardiologists

New Therapeutic Strategies for Type 2 Diabetes

Prediabetes: Why Should We Care?

Central Venous Pathologies: Treatments and Economic Impact

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

CASE REPORTS See More

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

Mycobacterium Chimaera Mimicking Sarcoidosis

Immune Checkpoint Inhibitor Related Cardiotoxicity

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

A Right Ventricular Mass

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EXCERPTA

The Other Side of the Prescription

EXCERPTA

Telemedicine Shakes Up the ICU Experience

POINTS TO REMEMBER

Venous Thrombosis in Nephrotic Syndrome

EDITORIALS

Letter to the Editor in response to “Role of Subcutaneous Leadless Implantable Cardioverter Defibrillator in Young Patients

Vol 14, Issue 2 (2018)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

A Giant Aortic Root Abscess

Jump to:
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.

Add Comments

Please login to dialogue with author.

Comments