{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:51:03Z","timestamp":1791982263594,"version":"4.4.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":87,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infective endocarditis (IE) complicated by aortic root abscess, fistulation and multivalve involvement is rare but carries high mortality. Fistulation from the left ventricular outflow tract (LVOT) to the right atrium (RA) represents an exceptionally uncommon sequela due to extensive perivalvular tissue destruction. Early surgical intervention remains crucial, but postoperative outcomes vary widely depending on host factors, organism control and the feasibility of durable reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report two cases of severe aortic valve endocarditis with aortic root abscess and acquired LVOT-RA fistula. The first patient had native-valve\n                      <jats:italic>Streptococcus mitis<\/jats:italic>\n                      endocarditis and underwent aortic and tricuspid valve replacement with double CardioCel patch repair of the fistula. He recovered after transient renal and hepatic dysfunction and completed six weeks of intravenous ceftriaxone. The second patient had prosthetic aortic valve endocarditis with aortomitral curtain destruction, pseudoaneurysm, severe malnutrition, and tricuspid involvement. He underwent redo sternotomy, aortomitral curtain reconstruction, double patch fistula repair, and triple bioprosthetic valve replacement. Although the initial repair was technically satisfactory, he later developed severe mitral paravalvular regurgitation with recurrent\n                      <jats:italic>Staphylococcus haemolyticus<\/jats:italic>\n                      bacteremia and died after deterioration with sepsis and multiorgan dysfunction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases illustrate the range of outcomes after complex endocarditis surgery. Patch-based reconstruction may be appropriate when radical debridement leaves sufficient tissue for secure prosthetic seating, whereas extensive prosthetic infection, malnutrition, recurrent bacteremia, and tissue friability increase the risk of late mechanical failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04491-1","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T23:56:14Z","timestamp":1784418974000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Complex infective endocarditis with perivalvular abscess and fistulation: two high-risk cases requiring extensive reconstruction and valve replacement"],"prefix":"10.1186","volume":"21","author":[{"given":"Marco","family":"Lizwan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin Yosef","family":"Widjaja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"See Hooi","family":"Ewe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuan Tong","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teing Ee","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip Y. K.","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"issue":"39","key":"4491_CR1","doi-asserted-by":"publisher","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","volume":"44","author":"V Delgado","year":"2023","unstructured":"Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948\u20134042. https:\/\/doi.org\/10.1093\/eurheartj\/ehad193. PubMed PMID: 37622656.","journal-title":"Eur Heart J"},{"issue":"6","key":"4491_CR2","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1016\/j.jtcvs.2016.09.093","volume":"153","author":"GB Pettersson","year":"2017","unstructured":"Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg. 2017;153(6):1241\u2013e125829. https:\/\/doi.org\/10.1016\/j.jtcvs.2016.09.093.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4491_CR3","doi-asserted-by":"publisher","unstructured":"Straw S, Baig MW, Mishra V, Gillott R, Witte KK, Van Doorn C, et al. Surgical Techniques and Outcomes in Patients With Intra-Cardiac Abscesses Complicating Infective Endocarditis. Front Cardiovasc Med. 2022;9. https:\/\/doi.org\/10.3389\/fcvm.2022.875870.","DOI":"10.3389\/fcvm.2022.875870"},{"key":"4491_CR4","doi-asserted-by":"publisher","first-page":"1154129","DOI":"10.3389\/fcvm.2023.1154129","volume":"10","author":"M Vobornik","year":"2023","unstructured":"Vobornik M, Timbilla S, Gofus J, Smolak P, Chek JL, Pojar M, et al. Aorto-mitral curtain reconstruction in invasive double-valve endocarditis: mid-term outcomes. Front Cardiovasc Med. 2023;10:1154129. https:\/\/doi.org\/10.3389\/fcvm.2023.1154129. PubMed PMID: 37234378; PubMed Central PMCID: PMC10206113.","journal-title":"Front Cardiovasc Med"},{"issue":"8","key":"4491_CR5","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.hlc.2024","volume":"34","author":"M Jaffar-Karballai","year":"2025","unstructured":"Jaffar-Karballai M, Al-Tawil M, Al-Zubaidi FI, Massias S, Kuku D, Vijayarasa V, et al. Aortic Root Replacement Versus Patch Repair for Aortic Valve Endocarditis With Root Abscesses: A Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes. Heart Lung Circ. 2025;34(8):777\u201388. https:\/\/doi.org\/10.1016\/j.hlc.2024. 12.008 PubMed PMID: 40312177.","journal-title":"Heart Lung Circ"},{"issue":"2","key":"4491_CR6","doi-asserted-by":"publisher","first-page":"ytaa548","DOI":"10.1093\/ehjcr\/ytaa548","volume":"5","author":"N Sunderland","year":"2021","unstructured":"Sunderland N, El-Medany A, Temporal J, Pannell L, Doolub G, Nelson M, et al. The Gerbode defect: a case series. Eur Heart J - Case Rep. 2021;5(2):ytaa548. https:\/\/doi.org\/10.1093\/ehjcr\/ytaa548.","journal-title":"Eur Heart J - Case Rep"},{"key":"4491_CR7","doi-asserted-by":"publisher","first-page":"15613","DOI":"10.1038\/s41598-023-41888-7","volume":"13","author":"A Ramos-Mart\u00ednez","year":"2023","unstructured":"Ramos-Mart\u00ednez A, Gonz\u00e1lez-Merino P, Suanzes-Mart\u00edn E, la Fuente MM, Escudero-L\u00f3pez G, Andr\u00e9s-Eisenhofer A, et al. Risk of endocarditis among patients with coagulase-negative Staphylococcus bacteremia. Sci Rep. 2023;13:15613. https:\/\/doi.org\/10.1038\/s41598-023-41888-7. PubMed PMID: 37730691; PubMed Central PMCID: PMC10511700.","journal-title":"Sci Rep"},{"issue":"15","key":"4491_CR8","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1161\/CIR.0000000000000296","volume":"132","author":"LM Baddour","year":"2015","unstructured":"Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435\u201386 https:\/\/doi.org\/10.1161\/CIR.0000000000000296. PubMed PMID: 26373316.","journal-title":"Circulation"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-026-04491-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-04491-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-026-04491-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:28:29Z","timestamp":1791980909000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-026-04491-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,19]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4491"],"URL":"https:\/\/doi.org\/10.1186\/s13019-026-04491-1","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,19]]},"assertion":[{"value":"2 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Written informed consents were obtained from patients to include the information in this manuscript. Institutional Review Board (IRB) approval was not required.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SHE receives speaker fees from Philips Healthcare, GE Healthcare, Edwards Lifesciences and Abbott Medical. The other authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"781"}}