Late Endocarditis on Aortic Prosthesis Complicated by an Infectious Aneurysm of the Right Sinus Ruptured in the Right Atrium: A Case Report

Abstract

Introduction: Endocarditis on aortic prosthesis that we all fear as patients with heart valve prosthesis, is a rare disease less than 1% of cases. However, its evolution is very unfavorable when it occurs. The appearance of a fever, often insidious, is a sure sign of the disease. Diagnosis is based on blood cultures and echocardiography. This clinical case is an opportunity for us to recall the seriousness of this condition both for patients and for cardiac surgeons. Methods: We report the case of an adult aged 51 with two mechanical mitro-aortic prostheses implanted in 2001 presenting endocarditis on aortic prosthesis complicated by aortic leak, atrioventricular block (AVB) and stroke leaving as a sequela a hemiplegia with infectious aneurysm of the right sinus ruptured in the right atrium (RA) in cardiac decompensation with persistent fever and orthopnea despite well-conducted triple anti-staphylococcal antibiotic therapy with clinical examination: aortic systolic murmur with crackling rales. Chest X-ray: cardiomegaly, flaky opacities, transthoracic echocardiography: large aneurysm on the right coronary side fistulized in the right atrium (RA), desinsertion of the aortic prosthesis with grade IV paraprosthetic aortic leak, left ventricular (LV): 52/32 mm, an undilated right ventricular (RV), an ejection fraction (EF) at 64 %, and finally a systolic arterial pulmonary pressure (SAPP) at 68 mmHg. Positive blood cultures: staphylococcus. Intraoperative exploration: voluminous vegetation next to the exit orifice of the aorta-right atrium fistula, desinsertion of the aortic prosthesis on the peri-annular abscess and vegetation on the aortic wings, destruction of the mitro-aortic junction with the presence of a fistula aorta-right atrium. He benefited from explantation of the aortic prosthesis, vegetation sent to bacteriology, reconstitution of the aortic annulus on the right coronary-left coronary (RC-LC) side by a Dacron® patch, closure of the entry orifice of the fistula on the aortic side by separate points and reconstruction of the mitro-aortic junction with a triangular Dacron® patch, implantation of an aortic prosthesis *Corresponding Author Late Endocarditis on Aortic Prosthesis Complicated by an Infectious Aneurysm of the Right Sinus Ruptured in the Right Atrium: A Case Report