Infective Endocarditis of the Autograft and the Neo–Aortic Root Following the Ross Operation

Figures

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  Figure 1. Five-month timeline including the time from Ross procedure up to aortic root repair because of endocarditis.

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  Figure 2. Two-dimensional transthoracic echocardiogram, parasternal basal short-axis (top row) and oblique, anterior angled, and apical long-axis (bottom row) views of the aortic root and RVOT without (A,D) and with (B,C,E,F) color flow Doppler in diastole (A,C,D,F) and systole (B,E), demonstrates turbulent flow into a prominent fluid collection noted anterior and slightly leftward of the aortic root, a defect in the right sinus of Valsalva (arrowheads in B and C), and flow communication between the dilated RVOT and the fluid collection just proximal to the pulmonary valve (arrowhead in D-F).

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  Figure 3. Two-dimensional transthoracic echocardiogram, apical (A) and suprasternal notch (B) views with color flow Doppler–guided continuous-wave Doppler spectral displays, demonstrates the continuous-flow, low-velocity profile from the fistulous connection between the pseudoaneurysm and the RVOT (A) and the holodiastolic flow reversal profile in the descending thoracic aorta (B).

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  Figure 4. CCT multiplanar reformatted images in axial (A) and coronal (B) displays and whole-heart, volume-rendered three-dimensional display, anterior perspective (C), demonstrate the aortic root with the fluid collection anteriorly and leftward between the aortic root and RV-PA conduit with erosion through the right sinus of Valsalva and fistulous connections between the aortic root and the RVOT (arrowheads); the pseudoaneurysm is well seen surrounding the anterior surface of the aortic root and extending into the rightward surface of the RVOT, but sparing involvement in the right coronary artery button.