Aortic Valve Replacement and CABG for Aortic Stenosis and Unstable Angina Combined with Active Infective Endocarditis.
10.4326/jjcvs.31.136
- VernacularTitle:感染性心内膜炎，冠動脈病変を合併した大動脈弁狭窄症・不安定狭心症の１手術例
- Author:
Naoto Miyagi
;
Hiroyuki Tanaka
;
Mikiko Murakami
;
Koso Egi
;
Satoru Hasegawa
;
Makoto Sunamori
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2002;31(2):136-138
- CountryJapan
- Language:Japanese
-
Abstract:
A 59-year-old man who had been treated medically for aortic stenosis and angina pectoris was hospitalized due to a high fever. He was treated immediately by intravenous infusion of antibiotics. Blood culture was positive for α-streptococcus. Echocardiography revealed severe aortic stenosis with vegetation on the aortic valve and minimal aortic regurgitation. The peak aortic pressure gradient was 80mmHg. The patient developed chest pain at rest and showed ischemic ST-segment depression on the electrocardiogram obtained after admission. Coronary angiography (CAG) was performed to assess the extent of coronary artery disease, and it showed 90% stenosis of the right coronary artery (RCA) and 75% stenosis of the circumflex branch (Cx). Both fever and angina pectoris were so resistant to maximal medical treatment that the patient was referred to our hospital for urgent surgical treatment. During surgery, a large vegetation was noted on the aortic valve, which was calcified, and a destructive ring abscess was observed around the coronary cusp. Aortic valve replacement (SJM-19mm) was performed after complete debridement of the abscess and repair of the resulting aortoventricular discontinuity. Double coronary bypass saphenous vein grafting to RCA and Cx was performed. The patient recovered without incident and was discharged 4 weeks after surgery.
