A modified David technique in endocarditis with multiple paravalvular abscesses.

A case is reported of infective endocarditis with extension into the annulus, presence of paravalvular abscesses, and fibrous body destruction. Treatment of this high-risk condition and eradication of infection represents a major surgical challenge. This 31-year-old patient was diagnosed with acute native aortic valve endocarditis caused by Staphylococcus aureus. He presented multiple paravalvular abscesses, left ventricular outflow destruction and fibrous body infection. Reconstruction of the intervalvular fibrous body was carried out with a single folded pericardial patch to simplify closure of the left atrium roof. In addition, the aortic root was reconstructed by the insertion of a composite graft attached to a semi-circumferential left ventricular outflow patch. The postoperative course was favorable, and transthoracic echocardiography after six months showed normal prosthesis function. In this type of situation, the extensive debridement of all infected tissues is mandatory, while surgery to eradicate the infection and restore functionality of the structures presents a formidable challenge.