Discussion
At present, surgical management of aortic valve endocarditis is based on the use of conventional stented mechanical, bioprostheses1,3, or when possible, stentless bioprostheses4.
In this case, the choice of this prosthesis was related to the poor quality of the aortic annulus. The reconstruction with the pericardial patch started deep within the interventricular septum and then covered and anchored the anterior mitral valve leaflet to the aortic wall. This was because of a gap generated by the deficiency of the deteriorated annulus. For this reason, we preferred not to use sutures with pledgets to pass in the area recently reconstructed with the patch, but instead we preferred to exclude this area using a rapid deployment bioprosthesis.
The subvalvular skirt of Intuity stabilized the prosthesis to the aortic annulus and excluded our reconstructed zone from the left ventricular outflow, with the aim of reducing the chance of interventricular defect reopening due to the left ventricle outflow blood jet. Additionally, the radial force could transmit solidity to the surrounding tissues and ensure more stability to the reconstructed structures
Finally, soon after the heart was reperfused, and an AV complete block was evident, we preferred to implant two definitive epicardial leads (atrial and ventricular) convenient for A-V pacing, avoiding intravascular leads that have more chances to complicate new cases of endocarditis in presence of positive blood cultures.
The patient continued the antibiotic therapy for 6 weeks following surgery. She was screened again after 6 months and she did not show any recurrences of endocarditis, prosthetic dysfunctions, or intracardiac shunts.