Managing Aorto-Mitral Abscess Endocarditis After Previous AVR With an LVOT Enlargement Procedure

This video demonstrates the case of a 60-year-old male patient who had streptococcus viridans endocarditis on a prosthetic valve.  This was his third operation, as he initially had a bioprosthetic valve and then, 10 years ago, Dr. Vince Gaudiani revised it with a mechanical valve and performed a mitral valve repair. However, the patient recently developed endocarditis with an abscess below the aortic valve.  

The venous return was drained before the cross-clamp was placed to ensure that no debris was displaced.  

The valve looked normal but came out easily due to the endocarditis, and once the valve was removed, a large abscess was found at the aorto-mitral continuity.  

This was extensively debrided, and the aorta was cut down in the same manner as for a left ventricular outflow tract (LVOT) enlargement procedure. Additionally, since the patient was a large gentleman, a large valve was required. 

A background patch was then placed to enlarge the annulus, and the sutures were positioned to accommodate the new 27 mm mechanical valve. Finally, the aorta was closed with the assistance of a Dacron patch. 

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