Composed aortic root replacement and left ventricular outflow tract reconstruction with translocated valve graft in a prosthesis infective endocarditis.

A 45-year-old female patient was admitted to the hospital because she presented with recurrent fever, chill, fatigue, and edema due to prosthesis infective endocarditis. Ten years prior, she had undergone mitral valve and aortic valve replacement using St. Jude mechanical valves (St. Jude Medical, St. Paul, MN, United States) as well as tricuspid annuloplasty due to severe rheumatic heart disease. Preoperative transthoracic echocardiography (TTE) and intraoperative transesophageal echocardiography (TEE) showed a severe perivalvular leakage (PVL) on the aortic valve (Supplementary Videos 1 and 2). Due to the derogative aortic annulus as well as fragility of the myocardium of left ventricular outflow tract (LVOT) because of abscess formation, she underwent composed aortic root replacement and LVOT reconstruction with a tube graft assembled by a translocated St. Jude R 19 mm mechanical valve (St Jude Medical, St Paul, Minn) and a 24 mm Gelweave prosthetic vessel graft (Vascutek Ltd, Inchinnan, United Kingdom). Translocation of prosthetic aortic valve (floating technique) was conducted to avoid the recurrence of PVL and lessen the possibility of a patient–prosthesis mismatch (PPM) (Fig. 1). The postoperative mean pressure gradient across the aortic valve was 30 mm Hg. There was no perivalvular leak-