Successful Surgical Intervention for Infected Mitral Endocarditis in a Patient Complicated with Multiple Cerebral Infarction and Hemorrhage
10.4326/jjcvs.45.37
- VernacularTitle:多発脳梗塞，脳出血を合併した僧帽弁位感染性心内膜炎に対し外科的治療により救命し得た1例
- Author:
Junki Yokota
;
Hiroyuki Nishi
;
Naosumi Sekiya
;
Mitsutomo Yamada
;
Toshiki Takahashi
- Publication Type:Journal Article
- Keywords:
infective endocarditis;
cerebral infarction;
cerebral hemorrhage;
surgical intervention
- From:Japanese Journal of Cardiovascular Surgery
2016;45(1):37-40
- CountryJapan
- Language:Japanese
-
Abstract:
The optimal timing of cardiac surgery for infective endocarditis in patients with severe brain complication remains unclear. We present here the successful surgical treatment of a case of infected mitral endocarditis with intractable heart failure, disseminated intravascular coagulation (DIC), and cerebral infarction with hemorrhage. A 37 year-old woman who received chemotherapy for breast cancer developed mitral infective endocarditis perhaps caused by infection of the implanted central venous access device and was referred to our hospital for an emergency operation. On admission, she had a mild fever and showed motor aphasia and right-sided hemiplegia. Brain CT scan findings revealed a cerebral infarction in the area of the left middle cerebral artery and a cerebral hemorrhage in the right occipital lobe. Echocardiography showed severe mitral regurgitation with huge mobile vegetation. Chest X-ray revealed severe pulmonary congestion and laboratory data showed DIC. After the mitral valve replacement with a bioprosthetic valve following complete excision of infected tissue, she was extubated on the first postoperative day with dramatic improvement of infectious signs and heart failure. Postoperative brain CT showed a new small brain hemorrhage, but no aggravation of the preoperative cerebral lesion. After she underwent surgical drainage for brain abscess on the 15th postoperative day, her postoperative course was uneventful. Even though this report is limited to a single case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.
