J Thorac Cardiovasc Surg 2003;125:725-727
© 2003 The American Association for Thoracic Surgery
From the Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo.
Received for publication May 16, 2002. Accepted for publication June 13, 2002. Address for reprints: Marc R. Moon, MD, Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, No. 1 Barnes-Jewish Plaza, St Louis, MO 63110 (E-mail: email@example.com).
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Surgical management of prosthetic valve endocarditis (PVE) remains a formidable challenge, especially for patients who continue intravenous drug use after successful initial treatment. 1,2 In an effort to reduce the rate of recurrent endocarditis, strategies including aortic valve repair and aortic root replacement with a homograft have been reported. 1,3 However, recurrent endocarditis of an aortic homograft represents a clinical problem without a well-established solution. This report details the treatment of a second recurrence of PVE in an intravenous drug user who had undergone homograft root replacement 11 months previously for endocarditis of an aortic valve bioprosthesis.
A 43-year-old woman with diabetes mellitus and a 25-year history of intravenous drug use was seen in June 2000 with a history of fever, chills, and a cough for several weeks. Blood cultures revealed Streptococcus sanguis. Transthoracic echocardiography revealed severe aortic insufficiency and a large vegetation on the noncoronary cusp of the valve. The development of severe congestive heart failure necessitated aortic valve replacement. At
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