Right-sided infective endocarditis (RSIE) localized to the right ventricular free wall is rare, and surgical excision of vegetations in such cases has seldom been reported. We describe a case of RSIE with the vegetations on the right ventricular free wall associated with ventricular septal defect (VSD) that was successfully treated with surgical intervention at an appropriate timing. The patient was a 30-year-old woman who had been diagnosed with a VSD shortly after birth. No surgical treatment had been performed and she had been followed conservatively. She was emergently transported to our hospital with disturbed consciousness caused by water intoxication due to psychogenic polydipsia. On admission, she presented with severe hyponatremia and elevated inflammatory markers. CT was performed, showing multiple bilateral pulmonary infiltrates, which were initially suspected to be pneumonia. After admission, blood cultures yielded Streptococcus mitis, and echocardiography showed two mobile vegetations on the right ventricular free wall, corresponding to a jet lesion caused by the VSD, leading to the diagnosis of RSIE. Subsequent contrast-enhanced CT showed filling defects in both pulmonary arteries, and septic pulmonary embolism (SPE) was diagnosed. Although antibiotic therapy improved inflammatory findings, the patient had a history of IE, which itself was an indication for VSD closure. In addition, we observed newly emerging, albeit minor, infiltrates in the lung fields. Therefore, we decided to proceed with elective surgery at that point. The vegetations on the right ventricular free wall was excised, the VSD was closed with an expanded polytetrafluoroethylene (ePTFE) patch, and the atrial septal defect incidentally found during surgery was also closed with direct sutures. Pathological examination of the excised specimen confirmed the infective vegetations. Including the period of postoperative oral antibiotic therapy, the total duration of antibiotic treatment was eight weeks. Her postoperative course was uneventful, and no recurrence was observed at 3 months after surgery.

A 73-year-old man had been followed up in our hospital after surgery for mitral regurgitation. At the age of 67, he underwent mitral valve plasty through a right mini-thoracotomy approach for atrial functional mitral regurgitation at our hospital. The mean trans-mitral pressure gradient was 5 mmHg after surgery but no heart failure symptoms were observed. At the age of 72, he began to notice fatigue during exertion. Transthoracic echocardiography revealed that the mitral valve regurgitation was controlled to a trace level, but the mean trans-mitral pressure gradient increased to 10 mmHg. Transesophageal echocardiography and contrast-enhanced cardiac computed tomography revealed the restricted opening of the mitral valve and pannus formation around the prosthetic ring. We thus diagnosed mitral stenosis due to pannus overgrowth. He underwent pannus excision and removal of the artificial ring. Postoperative echocardiography revealed that the mean trans-mitral pressure gradient was reduced to 3 mmHg and no residual mitral regurgitation was observed. He was discharged on postoperative day 11 with no major symptoms. He was in New York Heart Association functional class I at 1 year after the surgery and continues to be an outpatient.

A 41-years-old man with Marfan syndrome developed acute aortic dissection Stanford Type B. A new entry was located at the distal aortic arch. Medical treatment was given for a month, but the proximal descending aorta expanded to 50 mm. Because he had undergone partial arch replacement at the age of 36, thoracic endovascular aortic repair (TEVAR) using the synthetic graft as proximal landing zone was performed to close the entry. Six months after TEVAR, the false lumen around the stent graft disappeared. Distal stent graft-induced new entry (d-SINE) did not occur after TEVAR. Three years after TEVAR, we performed thoracoabdominal aortic replacement because of expansion of the residual false lumen without any complication. Endovascular therapy could be useful option for extensive aortic lesion even in Marfan syndrome.