A Case of Aortic Valve Replacement for Acute Severe Aortic Regurgitation Due To Infective Endocarditis

Reddy D, Lakshmana KCS and Kavyapriya PA

Published on: 2025-10-07

Abstract

Background: Acute aortic regurgitation (AR) is a life-threatening condition often caused by infective endocarditis, requiring urgent surgical intervention. This case report presents a patient with severe AR secondary to aortic valve endocarditis who developed cardiogenic shock and pulmonary edema, necessitating emergency aortic valve replacement (AVR).

Case Presentation: A 51-year-old male farmer with no comorbidities presented with fever, dyspnea, and pink frothy sputum. Clinical examination and echocardiography revealed severe AR due to perforation of the non-coronary cusp and root involvement. The patient was managed initially with non-invasive ventilation, vasopressors, and antibiotics. Following stabilization, he underwent AVR with debridement of an aortic root abscess and implantation of a mechanical valve.

Intraoperative Management: Cardiopulmonary bypass (CPB) was instituted using blood cardioplegia, with measures including pulsatile flow, ultrafiltration, and cell salvage to mitigate systemic inflammatory response syndrome (SIRS). The patient recovered postoperatively with delayed but progressive improvement in pulmonary function and was discharged on postoperative day 5.

Discussion: This case emphasizes the importance of perioperative strategies such as modified ultrafiltration, pulsatile perfusion, and early mobilization in improving outcomes and reducing the morbidity associated with SIRS in emergency cardiac surgeries.

Conclusion: Early recognition, timely surgical intervention, and intraoperative measures targeting SIRS are crucial in managing acute AR due to endocarditis, significantly influencing postoperative recovery and outcomes.