Heart 1999;81:62-66 ( January )
Urgent homograft aortic root replacement for aortic root abscess in infants and children
Great Ormond Street
Hospital for Children NHS Trust, London WC1N 3JH, UK
Correspondence to: Dr Sullivan.
Accepted for publication 14 July 1998
Objective
To assess
the results of early homograft aortic root replacement in infants and
children with an aortic root abscess.
DesignDescriptive
study of all patients with an aortic root abscess during 1987-97,
identified by retrospective review of the echocardiographic and
surgical registries.
SettingA
tertiary referral centre.
PatientsFive
patients (age 0.6 to 13 years; two female) were identified with an
aortic root abscess. Four had no known pre-existing congenital heart
abnormality. Three had a misleading presentation and were referred to
our hospital with non-cardiac diagnoses (fulminant hepatic failure;
adult respiratory distress syndrome; cerebrovascular accident). The
other two presented with septicaemia and a murmur, respectively. Blood
cultures identified Staphylococcus aureus (n = 3) and Streptococcus pneumoniae
(n = 2). Aortic root abscess was diagnosed by transthoracic echocardiography.
InterventionsHomograft
aortic root replacement with coronary reimplantation was performed
urgently (median one day after diagnosis).
ResultsFour patients
survived. The youngest died following multiorgan failure, multiple
aortic fistulae, three valve involvement, and extensive tissue
destruction preventing mitral valve replacement (S
pneumoniae). Two of the four survivors have required further surgery: mitral valve replacement (0.3 years later), and pulmonary autograft replacement of the homograft (8.3 years later). All survivors
remain in sinus rhythm and New York Heart Association functional class I.
ConclusionsInfective
endocarditis should be considered in any child with severe septicaemia
or embolic phenomena. Echocardiographic diagnosis of an aortic root
abscess indicates uncontrolled infection and impending haemodynamic
collapse. Homograft aortic root replacement can be performed
successfully in critically ill children with active infection.
© 1999 by Heart
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