What happens when a patient’s aorta falls off? - A rare case
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A 41-year-old man presented to a Hospital after collapsing 3 times at home. He had experienced headaches, double vision, and fever in the prior week. On admission, the patient had a temperature of 38.7, a BP of 102/61, and a heart rate of 97; a systo-diastolic murmur was heard on auscultation. His CRP was 275. Blood cultures were positive for Streptococcus oralis.

The patient had a dental abscess 1 week before the symptoms started. Three years previously, the patient had infective endocarditis and subsequently had his native bicuspid aortic valve replaced with a mechanical aortic valve. An ascending aortic replacement was also performed at the same time, due to dilatation.

A transoesophageal echocardiogram (TOE) was performed which showed a large vegetation on the aortic valve replacement and suspicion of an aortic root abscess adjacent to the non-facing sinus. The patient was transferred to a tertiary hospital and an electrocardiographically gated CT aortic angiogram was performed. This showed near complete dehiscence of the aortic valve from the native aortic root with a large false aneurysm mimicking a second aortic root.

The patient was taken for emergency revision surgery. Postoperatively the patient required implantation of a dual chamber permanent pacemaker and was eventually discharged from hospital 1 month after his emergency surgery. He recovered well at home and remains well on long-term follow-up.

Source: https://academic.oup.com/ehjcr/advance-article/doi/10.1093/ehjcr/ytaa220/5893668?rss=1
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