Minimally Invasive Repair of Severe Bicuspid Aortic Valve Endocarditis

For young patients with aortic valve endocarditis, preserving the native aortic valve, when feasible, may be the best option. The authors demonstrate the feasibility of performing a complex aortic valve repair for aortic valve endocarditis via an upper partial sternotomy.

This is the case of 31-year-old man who presented with fever and lethargy. A CT scan of the abdomen showed multiple left renal infarcts. The blood cultures were positive for Streptococcus, and a TEE showed a bicuspid aortic leaflet with echodensity and severe aortic valve regurgitation.

A minimally invasive approach was performed through a 6 cm skin incision and an upper partial sternotomy, with extension to the third right intercostal space. The evaluation of the aortic valve showed prolapse of the conjoined left and right leaflets with vegetations on the undersurface of the leaflet. The noncoronary leaflet had vegetations and a perforation. All vegetations were excised, and the perforation was cleaned and closed with a piece of Xenograft pericardium. The conjoint leaflets and noncoronary cusp were plicated on the free edge for an effective height of 9 mm. The root was circumferentially mobilized and a Teflon felt ring was placed underneath the coronaries to create an atrioventricular junction of 25 mm. TEE showed trace aortic valve insufficiency. The patient had an uneventful hospital course.

Repair of aortic valve endocarditis with the perforation of the cusp can be feasible and beneficial in a certain group of patients.