P95 A RARE CASE OF INFECTIOUS AORTITIS

Abstract

Abstract Aortitis is an inflammatory process affecting the arterial wall. There are infectious and non–infectious forms. While the non–infectious forms can be linked to arteritis of the large vessels, the infectious forms are a rare but fearful complication of infective endocarditis. In this case the most affected pathogenic species are gram positive bacteria such as streptococci and enterococci. An 81–year–old patient, hypertensive, with permanent atrial fibrillation, subjected to previous aortic valve replacement (with Intuity 27 mm bioprosthesis for severe stenosis in 2016) and with previous pulmonary embolism in 2021, was admitted to emergency department for oliguria and worsening ankle swelling in December 2022. The haemodynamic parameters at the hospital admission were stable. A transthoracic echocardiography was performed, which highlighted a vegetation of about 2 cm on the aortic bioprosthesis with mild stenosis and negligible intraprosthesis regurgitation. A cerebral and thoraco–abdominal CT angiography showed multiple thromboembolic outcomes involving the splanchnic vessels, kidney and spleen. The patient was then subjected to transesophageal echocardiography which highlighted the presence of vegetation on the bioprosthesis with diameters of 12x12 mm; moreover, aneurysmal dilatation of the aortic root was found with the presence, both anteriorly and posteriorly of the wall, of a thickening of about 1 cm which extended up to the sino–tubular junction. The patient‘s hospitalization was also complicated by intestinal subocclusion without urgent surgical indications.The patient‘s case was discussed collectively and it was decided, in the light of the high risk of intestinal ischemia (linked to the thromboembolic occlusion of the splanchnic vessels) not to subject the patient to cardiac surgery. In a recent publication of a case report with literature review, 12 cases were reported, all treated surgically, of which 2 died. Our patient, unable to undergo surgical therapy, represents the first case treated with medical therapy alone. To date, the patient is still hospitalized, in stable haemodynamic conditions, with a unfavorable long–term prognosis.