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Infective endocarditis affecting the aortic valve may be complicated by an abscess cavity in the aortic root,1-3 and this is more frequent and serious in prosthetic than native valve infections.4 5 Successful management of this condition, which has high morbidity and mortality, invariably requires surgical repair, and depends on early diagnosis, clear preoperative anatomical definition, and maintaining the sterility of the second implant. Homograft valves offer many advantages: they are resistant to infection,1 6 7 prosthetic material is not involved, and the abscess cavities can be excluded from the circulation.7-9 There are further potential advantages from the use of homografts in children. Experience with aortic root abscess in infants and children is very limited; Chaturvedi and colleagues describe their experience with five cases collected over 10 years at a supraregional referral centre, a testimony to the rarity of the condition in paediatric practice.10 We have little experience of this condition in children, and this review is based on experience gained in managing adults.
The terminology of aortic root abscess is rather misleading. Strictly speaking the uncontrolled infection causes a mycotic aneurysm of one of the sinuses of Valsalva, which is in free communication with the aortic root above the valve cusps; this may often result in paravalvar regurgitation directly to the left ventricular outflow tract. A true enclosed abscess cavity very rarely, if ever, develops. Fistulous communication to other cardiac chambers is well recognised.9
Three of Chaturvedi et al’s patients were infected with Staphylococcus aureus and two with Streptococcus pneumoniae; both virulent aggressive pathogens capable of attacking a normal valve as well as one that is structurally abnormal. Three of their patients (who all had native valve infection) had no underlying cardiac defect detected and the other two had bicuspid aortic valves. …
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