The anatomical basis of infection of the aortic root.

Although images of large abscess cavities in the aortic root in the presence of infection may be obtained by echocardiography or angiocardiography, discrete cavitations and paravalvar leaks, especially small ones, tend to remain unrecognized. Furthermore the abscesses themselves and their extent are often difficult to locate at operation, and it is this difficulty in delineating paravalvar foci of destruction which remains a major surgical challenge in aortic infections. The inability of current imaging techniques to elucidate this problem is compounded by the limited access which aortotomy gives to the aortic root. In the case of prosthetic valve endocarditis, the aortic root is often distorted, this distortion is greater where more than one prosthetic valve has been used, so that identification of septic areas and abscess cavities may further be obfuscated. Five necropsy specimens of normal hearts and 10 with infective endocarditis of either natural or prosthetic valves in either aortic or atrioventricular position were studied to elucidate the anatomy of the aortic root and to identify sites of potential abscess formation and of rupture.