Late complications of the Rastelli procedure - infective endocarditis and homograft stenosis: A case report

Elena-Andreea Sava; Ilie-Marius Ciorba; Claudiu-Ionut Sântean; Andrei Manea; Nicoleta-Maria Crăciun-Ciorba

doi:10.2478/jccm-2026-0007

Figures & Tables

A. Chest CT scan: Large bilateral pleural effusions with atelectasis; Mild pectus excavatum with a Haller index of 2.28; B. Abdominopelvic CT scan: Large amount of ascites; C. Abdominal CT scan: Splenic infarcts

Cardiac CT scan with intravenous contrast: Homograft stenosis-reduction in the diameter of the conduit connecting the right ventricle to the pulmonary artery from 14 mm to 4.29 mm

3D reconstruction of the heart showing the homograft conduit connecting the right ventricle to the pulmonary artery

Chest X-ray after bilateral thoracentesis – no condensation foci, no signs of pneumothorax

Laboratory tests and diuresis

Laboratory test	Day 1	Day 3	Day 5	Day 7	Day 8	Day 9	Day 10	Day 12	Day 14	Day 16	Day 18	Day 20	Day 23	Reference Range
Leukocytes	32500	28300	23700	20000	25100	27200	31100	27400	21600	17500	13100	9900	10000	3600–10000/μL
Neutrophils	28000	24200	20600	17300	21000	23700	26900	22100	16300	11400	9600	7800	7900	1400–6500/μL
Hemoglobin	9.33	9.4	9.2	9	8.9	8.8	8.8	9.1	9.4	9.85	9.6	9.3	9.1	13–17g/dL
Platelets	154000	143000	150000	149000	133000	121000	112000	117000	126000	123000	117000	119000	116000	150000–450000/μL
C reactive protein	140.5	122.5	110.5	70	140	219	243	194	152	93	40	10	15	0–5mg/L
Procalcitonin	14.54			5			12.3				8		6	<0.5mg/L
Presepsin	1369			714			1236				744		432	100–200 pg/mL
NT-proBNP	23614								21500					<125pg/mL
AST	24		25	18			22		18		23		30	5–34U/L
ALT	5		7	6			6		6		7		8	0–55U/L
Total bilirubin	1.42		1.37	1.27			1.22		1.09		1.26		1.41	0.2–1.2 mg/dL
Albumin	3.06						3.0							3.97–4.94 g/dL
Total protein	6.19						6.1							6.4–8.3 g/dL
INR	1.17		1.04		0.94			0.9		0.92			0.96	0.8–1.2
Sodium	136	134	134	133	133	132	132	131	130	130	130	130	130	136–145 mmol/L
Potassium	3.67	3.5	3.63	3.69	3.7	3.74	3.76	3.8	3.6	3.5	3.4	3.6	3.5	3.5–5.1 mmol/L
Glucose	94	106	101	95	88	78	83	96	99	94	121	117	104	70–105 mg/dL
pH	7.31	7.33	7.32	7.35	7.36	7.35	7.33	7.33	7.31	7.3	7.29	7.26	7.2	7.35–7.45
PO₂	65	68	70	71	72	71	72	71	70	70	71	70	70	75–100 mmHg
PCO₂	49	44	43	44	46	49	51	53	53	54	54	55	65	35–45 mmHg
P(A-a)O₂	158,95	162,2	161,45	159,2	155,7	152,95	149,45	147,95	148,95	147,7	146,7	146,45	133,95	mmHg
FShunt	39	22	20	21	20	21	32	30	26	28	30	33	37	%
HCO₃	18	19	21	22	23	22	20	19	19	18	18	17	20	22–26mEq/L
SaO₂	75	88	90	89	90	89	84	85	87	86	85	80	78	95–100%
Lactate	3.6	3.5	3.4	3.1	3.2	3.3	3.5	3.1	2.9	2.8	3.0	3.1	3.2	<2mmol/L
Urea	117	89	87	81	70	74	72	71	72	79	85	82	79	19.04–44.08 mg/dL
Creatinine	2.85	2.31	2.23	2.01	1.62	1.85	1.9	1.76	1.79	2.07	2.11	2.15	2.16	0.72–1.25 mg/dL
Diuresis	3L	3.2L	3L	2.8L	2.9L	3.3L	3.1L	3L	2.7L	2.8L	2.6L	2.7L	2.5L

Late complications of the Rastelli procedure - infective endocarditis and homograft stenosis: A case report

Figures & Tables

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Laboratory tests and diuresis

Paradigm

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