P194 DESTRUCTIVE AORTIC VALVE ENDOCARDITIS WITH INVOLVEMENT OF THE MITRO–AORTIC CURTAIN: A SUCCESSFUL “UFO” PROCEDURE

Abstract

Abstract Infective endocarditis is a relatively rare disease with an estimated mean incidence of 3.6–7.0 cases per 100,000 subject–years. Aortic bicuspid disease, the most frequent congenital anomaly, is one of the main risk factors. Heart failure, uncontrolled infection (fistulas, abscesses, persistently positive blood cultures) and systemic embolization are among the most feared complications of endocarditis: these cases constitute an indication for emergency/urgent cardiac surgery. An example of extremely demolitive surgery is the Commando or "UFO" procedure, which consists in the double replacement of the aortic valve and the mitral valve with reconstruction of the mitro–aortic junction. The clinical case concerns a 36–year–old man who went to the emergency room for high fever with shivering. Having been found positive blood cultures for MSSA and having emerged mitro–aortic vegetation by echocardiogram, a diagnosis of infective endocarditis was made. During hospitalization, multi–organ cardioembolic phenomena (e.g. splenic, cerebral) with hemorrhagic cerebral infarction occurred: therefore, in accordance with current guidelines, a conservative treatment was temporarily opted for. However, in the following days the deterioration of the clinical–haemodynamic picture was such as to require emergency cardiac surgery. The patient was thus subjected to Commando or UFO procedure with reconstruction of the mitral–aortic junction. Severe bi–ventricular dysfunction was found for the first time at post–operative echocardiographic control, with the need for mechanical support to the circulation (AV ECMO, Impella). The remainder of the hospitalization was characterized by a progressive recovery of ventricular function (LVEF 16% to 44%), therefore patient was discharged in discrete hemodynamic compensation, despite the multiorgan sequelae (hepatic, neurological, renal).