Tissue composite graft lacking sinuses may well prone to develop endocarditis post aortic root replacement: An untested hypothesis

A 72 year-old female with acute prosthetic aortic root endocarditis and systolic congestive heart failure underwent a homograft revision within 6-months. Initially she underwent root replacement with a straight composite graft for a severely stenotic aortic valve and root dilatation. Over a 6-month period, she developed a progressively audible holosystolic murmur. Echocardiography demonstrated a vibrating stuttering of the prosthetic valve cusps on M-mode. This was exaggerated with aortic root endocarditis vegetations on cusps. We hypothesize that this repetitive severe turbulent flow related to a Venturi effect damaged the straight tube graft-aortic root and prosthetic valve cusps in our case.