Homograft Replacement of the Pulmonic Root for IVDU-Associated Endocarditis
Jonathan M. Hemli, Paley G. Arnone, Antonio J. Guirola, Karthik Seetharam, Jui-Chuan Tseng, S Jacob Scheinerman, Derek R. Brinster.
Lenox Hill Hospital / Northwell Health, New York, NY, USA.
OBJECTIVE: Endocarditis in intravenous drug users (IVDU) presents unique challenges in management, not the least of which is the potential risk for reinfection with continued substance abuse. We demonstrate replacement of the entire pulmonic root with an aortic homograft for destructive endocarditis of the pulmonic valve in an active drug user. METHODS: Our technique for replacing the entire pulmonic outflow complex is demonstrated in a 27 year-old male with continued substance use, who presents with methicillin-sensitive Staphylococcus aureus sepsis, a large mobile mass on the pulmonic valve associated with severe pulmonic insufficiency, and multiple septic emboli to the lungs. RESULTS: As illustrated in the video presentation, the pulmonic valve was almost completely replaced by vegetations. A pulmonic root abscess was also present, and the infective process extended down into the right ventricular outflow tract (RVOT). After aggressive debridement of all infected tissue, an appropriately sized aortic homograft was used to reconstruct the RVOT, the pulmonary valve and the proximal main pulmonary artery. CONCLUSIONS: Pulmonic valve endocarditis is relatively uncommon, except in special clinical situations. An aortic homograft affords unique advantages in destructive endocarditis in an IVDU, especially given the potential risk of future reinfection in this patient population.
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