Vol. 24 No. 4 (2020)
CASE REPORTS

Surgical treatment of an aortic root abscess in a patient with HIV / AIDS

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  • S. Stefanov,
  • S. Gasymova,
  • K. Smolianinov,
  • L. Rakhmatulina
S. Stefanov
District Clinical Hospital of the Khanty-Mansiysk Autonomous Okrug of Ugra, Khanty-Mansiysk
S. Gasymova
District Clinical Hospital of the Khanty-Mansiysk Autonomous Okrug of Ugra, Khanty-Mansiysk
K. Smolianinov
District Clinical Hospital of the Khanty-Mansiysk Autonomous Okrug of Ugra, Khanty-Mansiysk
Bio
L. Rakhmatulina
District Clinical Hospital of the Khanty-Mansiysk Autonomous Okrug of Ugra, Khanty-Mansiysk
DOI: https://doi.org/10.21688/1681-3472-2020-4-134-140

Published 2020-12-30

Keywords

  • acquired immunodeficiency syndrome,
  • aortic root abscess,
  • infectious endocarditis,
  • clinical case,
  • HIV-infected patient

How to Cite

Stefanov, S., Gasymova, S., Smolianinov, K., & Rakhmatulina, L. (2020). Surgical treatment of an aortic root abscess in a patient with HIV / AIDS. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 24(4), 134–140. https://doi.org/10.21688/1681-3472-2020-4-134-140

Copyright (c) 2020 Stefanov S.A., Gasymova S.Sh., Smolianinov K.A., Rakhmatulina L.K.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

The successful surgical treatment of infectious endocarditis with abscess of the aortic root in a patient with HIV infection and immunodeficiency is presented in this clinical case study. The paper discusses the tactical aspects of the technique of surgical intervention and management features associated with the presence of HIV infection.
In patients with HIV-related immunosuppression, similar to other patients with infectious aortic valve endocarditis with aortic root destruction, the method of choice is an early surgical treatment with radical debridement and subsequent reconstruction of the aortic root.
The type of reconstruction depends on the degree of destruction. Choice of valves does not significantly impact survival, freedom from recurrence of endocarditis or reoperation due to reinfection. Preventive implantation of epicardial electrodes with a formed or complete atrioventricular block is not advisable due to the high risk of secondary infection of the endocardial electrodes and persistence of sepsis.

Received 30 April 2020. Revised 13 July 2020. Accepted 28 July 2020.

Conflict of interest: Authors declare no conflicts of interest.

Funding: The study did not have sponsorship.

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References

  1. Шевченко Ю.Л., Хубулава Г.Г., Шихвердиев Н.Н., Матвеев С.А. Инфекционный эндокардит как хирургическая проблема в России. Вестник хирургии им. И.И. Грекова. 2003;162(2):12-16. [Shevchenko Yu.L., Khubulava G.G., Shikhverdiev N.N., Matveev S.A. Infective endocarditis as a surgical problem in Russia. Grekov's Bulletin of Surgery. 2003;162(2):12-16. (In Russ.)]
  2. Anguera I., Miro J.M., Cabell C.H., Abrutyn E., Fowler V.G. Jr, Hoen B., Olaison L., Pappas P.A., de Lazzari E., Eykyn S., Habib G., Pare C., Wang A., Corey R., ICE-MD investigators. Clinical characteristics and outcome of aortic endocarditis with periannular abscess in the International Collaboration on Endocarditis Merged Database. Am J Cardiol. 2005;96(7):976-981. PMID: 16188527. https://doi.org/10.1016/j.amjcard.2005.05.056
  3. Сулейманов Б.Р., Муратов Р.М. Современные подходы к хирургическому лечению инфекционного эндокардита аортального клапана, осложненного деструкцией корня аорты. Грудная и сердечно-сосудистая хирургия. 2012;(2):7-12. [Suleymanov B.R., Muratov R.M. Modern approaches to surgical treatment of infective endocarditis of aortic valve complicated by aortic root destruction. Russian Journal of Thoracic and Cardiovascular Surgery = Grudnaya i serdechno-sosudistaya khirurgiya. 2012;(2):7-12. (In Russ.)]
  4. Leontyev S., Borger M.A., Modi P., Lehmann S., Seeburger J., Doenst T., Mohr F.W. Surgical management of aortic root abscess: A 13-year experience in 172 patients with 100 % follow-up. J Thorac Cardiovasc Surg. 2012;143(2);332-337. PMID: 21724196. https://doi.org/10.1016/j.jtcvs.2010.10.064
  5. Yankah A.C., Pasic M., Klose H., Siniawski H., Weng Y., Hetzer R. Homograft reconstruction of the aortic root for endocarditis with periannular abscess: a 17-year study. Eur J Cardiothorac Surg. 2005;28(1):69-75. PMID: 15982588. https://doi.org/10.1016/j.ejcts.2005.03.017
  6. Valencia Ortega M.E., Guinea Esquerdo J., Enríquez Crego A., Moreno Celda V., Laguna Cuesta F., González Lahoz J. Left-sided endocarditis in patients with HIV infection. An Med Interna. 1999;16(4):171-174. PMID: 10339840
  7. Cicalini S., Forcina G., De Rosa F.G. Infective endocarditis in patients with human immunodeficiency virus infection. J Infect. 2001;42(4):267-271. PMID: 11545570. 7. https://doi.org/10.1053/jinf.2001.0812
  8. Miró J.M., del Río A., Mestres C.A. Infective endocarditis and cardiac surgery in intravenous drug abusers and HIV-1 infected patients. Cardiol Clin. 2003;21(2):167-84. PMID: 12874891. 8. https://doi.org/10.1016/s0733-8651(03)00025-0
  9. Nakamura Y., Tagusari O., Kobayashi J., Nakajima H. Secure anastomosis for damaged aortic root reconstruction: Graft insertion technique. J Thorac Cardiovasc Surg. 2011;142(4):948-950. PMID: 21457997. https://doi.org/10.1016/j.jtcvs.2011.02.032
  10. Bakhtiary F., El-Sayed Ahmad A., Borger M. Modification of reconstruction of intervalvular fibrous body for extensive infective endocarditis. Ann Thorac Surg. 2020;109(3):e211-e214. PMID: 31610164. https://doi.org/10.1016/j.athoracsur.2019.09.020
  11. Yanagawa B., Mazine A., Tam D.Y., Jüni P., Bhatt D.L., Spindel S., Puskas J.D., Verma S., Friedrich J.O. Homograft versus conventional prosthesis for surgical management of aortic valve infective endocarditis: A systematic review and meta-analysis. Innovations (Phila). 2018;13(3):163-170. PMID: 29912740. https://doi.org/10.1097/imi.0000000000000510