Infective Endocarditis 2 Decades After Pulmonary Autograft Ross Procedure

Robin Boyer,Greti Petersen,Arash Heidari,Fowrooz Joolhar,Charnpreet Upple

doi:10.1177/2324709620940490

Robin Boyer, Greti Petersen + Show 3 more

Open Access

https://doi.org/10.1177/2324709620940490

Copy DOI

Abstract

Pulmonary autograft, or Ross procedure, is performed by supplanting a diseased aortic valve with the patient’s own pulmonary valve. Reconstruction of the right ventricular outflow tract is then completed using a pulmonary homograft. To our knowledge, infective endocarditis occurring decades after the Ross procedure has not been reported. Diligent echocardiographic examination can be crucial to ensure prompt treatment and avoid the 25% mortality rate associated with infective endocarditis. Clinical suspicion should remain high in those with a pulmonary autograft history. In this article, we report the case of a 39-year-old patient with infective endocarditis presenting 22 years after Ross procedure.

Highlights

The pulmonary autograft, or Ross procedure, was initially performed in 1967 by cardiothoracic surgeon Dr Donald Ross.[1]
By preserving the endothelium and endocardium, the autograft maintains the ability to fight infection leading to lower rates of infective endocarditis (IE).[1]
We report the case of a 39-year-old patient with IE presenting 22 years after Ross procedure

Summary

Introduction

The pulmonary autograft, or Ross procedure, was initially performed in 1967 by cardiothoracic surgeon Dr Donald Ross.[1]. Diagnosis is satisfied through a combination of clinical presentation, positive blood cultures, and echocardiographic characteristics.[5] The current diagnostic gold standard is established with the modified Duke criteria It is sensitive and specific for IE based on major and minor criteria categorizing patients as either definite, possible, or rejected.[6]. The patient self-treated a reported 101.7 °F temperature at home with acetaminophen Her history was significant for a bicuspid aortic valve corrected with aortic balloon valvuloplasty followed by Ross procedure at age 17. TEE indicated severe pulmonic stenosis with an elevated right ventricular systolic pressure of 90 mm Hg, pulmonary artery maximum velocity of 4.7 m/s, and peak gradient of 88 mm Hg. Left ventricular ejection fraction was similar to the previous TTE at 60%. She began a 6-week course of intravenous ceftriaxone and gentamicin

Discussion

Findings

Conclusion