| Abstrakt: |
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, AVB and stroke leaving as a sequela a hemiplegia with infectious aneurysm of the right sinus ruptured in the RA in cardiac decompensation with persistent fever and orthopnea despite well-conducted triple antistaphylococcal antibiotic therapy with clinical examination: aortic systolic murmur with crackling rales. Chest X-ray: cardiomegaly, flaky opacities, echocardiography: large aneurysm on the right coronary side fistulized in the RA, disinsertion of the aortic prosthesis with grade IV para-prosthetic aortic leak, LV: 52/32 mm, an undilated RV, an EF of 64, and finally a SAPP of 68 mmHg. Positive blood cultures: staphylococcus. Intraoperative exploration: voluminous vegetation next to the exit orifice of the aorta-RA fistula, disinsertion 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-RA. He benefited from explantation of the aortic prosthesis, vegetation sent to bacteriology, reconstitution of the aortic annulus on the 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 tube, implantation of an aortic prosthesis in the annular position and finally closure of the orifice of the fistula on the auricular side with a dacron patch under cardiopulmonary bypass. Results: The postoperative follow-up was simple. Conclusion: We underline the major interest of the prevention and the essential treatment of any infectious hearth, in particular ENT and dental, at the carriers of cardiac prostheses. [ABSTRACT FROM AUTHOR] |
