Aortic endocarditis complicated with a large ventricular septal defect and septic pulmonary embolism

Infectious complications of the aortic valve can lead to severe cardiac failure and widespread contiguous lesions by the involvement of subaortic structures such as aorto-left ventricular discontinuity, destruction of the aortic ring, aortic abscesses, true or false aneurysms and shunts. Report a new case of a large ventricular septal defect due to infection. Abnormal communications occurring during acute aortic valve endocarditis are rare but they are very serious complications. We report a case of a 58 year-old-man, referred to our hospital with the diagnosis of aortic endocarditis with complicating root abscesses, acquired ventricular septal defect [VSD] and pulmonary septic embolism. Surgery was indicated and the whole procedure was performed through the aortic root. The patient underwent a radical resection of the abscesses, reconstruction of the aortic ring, closure of the ventricular septal defect and prosthetic replacement of the aortic valve. The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse. The authors would like to select and analyze some weaknesses of their procedure like using only the transaortic access that often limits exposure of possible right-side lesions, not removing the pulmonary obstruction and using an important amount of foreign material to reconstruct subvalvular lesions

[Non penetrating cardiac trauma]

Traffic accidents are a very important leading cause of death in young adults in our country and the most cause of non penetrating cardiac trauma. Cardiac contusions represent the most common form of non penetrating cardiac trauma but a wide spectrum of cardiac injury ranging from, cardiac valve is not usually foremost in the minds of physicians dealing with acutely injured patients because initial screening is usually focused on other classic and common injuries. There is actually no controversies surrounding the fact that transoesophageal echocardiography is becoming the corner stone and the most useful modality of the evaluation of severe chest trauma with suspicion of cardiac injury. This paper describe the most important blunt cardiac injuries and emphasizes indirectly the need for early diagnosis that becomes an easy one, if the physician keeps in mind such a possibility in all traumatised patients. Another concern is to point out the importance of appropriate therapeutic approach that may significantly improve outcomes in patients with blunt cardiac trauma