Document Detail

Successful surgical treatment with mitral valve replacement and coronary embolectomy in a patient with active infective endocarditis complicated by multiple septic embolisms involving cerebral arteries and the right coronary artery.
MedLine Citation:
PMID:  20859727     Owner:  NLM     Status:  MEDLINE    
The proper management of a patient with active infective endocarditis (IE) remains to be determined, especially when his or her condition is complicated with intracranial mycotic aneurysm. Here we present a 46-year-old company employee hospitalized with a subarachnoid hemorrhage caused by a ruptured mycotic aneurysm. Cardiac echography showed a verruca on the posterior mitral cusp and leaflet destruction, resulting in severe valvular regurgitation (determined pathogen was α-streptococcus). High-dose antibiotic infusion and restriction of physical activity to prevent heart failure were combined with emergency craniotomy drainage and coiling of the necks of two cerebral mycotic aneurysms. After 2 months of conservative therapy for IE, he suddenly collapsed with hypotension and bradycardia because of embolic occlusion of the proximal right coronary artery (RCA). An emergent operation was carried out to remove the emboli in the RCA and to replace the mitral valve with a mechanical prosthesis. The postoperative course was uneventful. Although disturbances of spatial recognition and manual dexterity remained, he was able to walk and talk. After postoperative sufficient-duration antibiotic therapy, which lasted 20 days, he was transferred to a rehabilitation center.
Manabu Yamasaki; Sunao Watanabe; Kohei Abe; Michiko Uenishi; Kohei Kawazoe
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-09-22
Journal Detail:
Title:  General thoracic and cardiovascular surgery     Volume:  58     ISSN:  1863-6713     ISO Abbreviation:  Gen Thorac Cardiovasc Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101303952     Medline TA:  Gen Thorac Cardiovasc Surg     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  471-5; discussion 476     Citation Subset:  IM    
Department of Cardiovascular Surgery, Heart Center, St. Luke's International Hospital, 9-1 Akashicho Chuo-Ku, Tokyo, 104-8560, Japan.
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MeSH Terms
Coronary Angiography
Coronary Vessels*
Embolism / diagnosis,  etiology,  microbiology
Endocarditis / complications,  surgery*,  ultrasonography
Heart Valve Prosthesis Implantation*
Intracranial Aneurysm / etiology,  radiography
Intracranial Embolism / etiology,  microbiology,  radiography
Middle Aged
Mitral Valve*

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