A surgically salvaged case: emergency Root-Commando procedure for infective endocarditis and chronic dissecting aneurysm of the sinus of Valsalva

TL;DR

A 41-year-old man with severe heart conditions was successfully treated with an emergency Root-Commando procedure, a high-risk surgery for infective endocarditis.

Contribution

This case highlights the successful use of the Root-Commando procedure in a complex, life-threatening cardiac scenario.

Findings

Emergency Root-Commando surgery saved a patient with infective endocarditis and a dissecting aneurysm.

The patient survived and was discharged after 47 days, including a reoperation on postoperative day 30.

The procedure was effective despite the high 1-year mortality rate typically associated with this surgery.

Abstract

The Commando procedure for infective endocarditis is a high-risk intervention. However, infective endocarditis involving the intervalvular fibrosa is fatal in the absence of surgery. A 41-year-old man with no medical history visited a doctor with chest pain and dyspnoea. Ascending aortic dissection and vegetation on the mitral valve were noted on echocardiography, so he was transferred to our hospital. The diagnosis was dissecting aneurysm of the sinus of Valsalva and acute heart failure due to aortic regurgitation, mitral regurgitation and infective endocarditis. We decided on emergency surgery. Intraoperatively, we confirmed abscess extending to the left atrial roof and destruction of the intervalvular fibrosa, so we performed the Root-Commando procedure. The patient was saved and discharged 47 days after transfer to our hospital through the reoperation on postoperative day 30.

The Commando procedure for infective endocarditis (IE) is a high-risk procedure with a 1-year mortality rate of 20–30% [1].

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