Dual side-graft cannulation of the axillary artery and femoral artery for cardiopulmonary bypass in acute type a dissection involving aortic arch

Abstract

We present the case of a previously well seventyfour year-old male Caucasian grazier who presented with mild back pain and was subsequently found to have a large posterior mitral valve leaflet perivalvular abscess associated with mitral annulus calcification and a mycotic infrarenal abdominal aortic aneurysm (AAA) of Staphylococcal origin. He underwent a right axillofemoral bypass with oversewn aorta and a right to left femoral crossover graft, and a subsequent mitral valve repair with decalcification/debridement of the annulus and extensive posterior leaflet reconstruction with pericardium patch. Despite multiple sequelae and an extended intensive care and hospital stay, the patient was discharged home after six months. Background:Mitral annulus abscess associatedwithmitral annulus calcification is a rare but serious form of endocarditis which, though little-reported, imposes a significant increase in technical difficulty ofmitral valve repair, has important implications regarding patient selection and operative technique, and carries an increase in morbidity and mortality. Treatment: Visual inspection of the valve revealed a gross distortion of the posterior leaflet with a large vegetation and P1/P2 abscess cavity in the setting of circumferential mitral annulus calcification (Figure 3) with the posterior annulus most severely affected. The diseased valve leaflet was detached, the adjacent abscess debrided, and the mitral Abstracts e39