Late aortic root pseudoaneurysm after pericardial patch reconstruction for bicuspid aortic valve endocarditis: a case report.

A 70-year-old male with bicuspid aortic valve developed oxacillin-sensitive Staphylococcus aureus bacteremia complicated by infective endocarditis, aortic root abscess, and embolic stroke. Initial management included aortic valve replacement with a bioprosthetic valve, aortic root reconstruction with bovine pericardial patch, and anterior mitral leaflet repair. Despite appropriate antimicrobial therapy, the patient developed recurrent symptoms three years later. Transesophageal echocardiography revealed severe aortic regurgitation and a large pseudoaneurysm resulting from dehiscence of the previous pericardial patch repair. The patient underwent successful repeat sternotomy with aortic root replacement using a valved conduit and reimplantation of coronary arteries. This case highlights the challenging nature of endocarditis involving the aortic root, particularly when complicated by abscess formation requiring patch reconstruction, and emphasizes the importance of long-term surveillance for pseudoaneurysm formation following such complex repairs.