A Case of Aortic Homograft Root Replacement for Active Infective Endocarditis Complicated by Multiple Cerebral Infarctions and Disorders of Consciousness
- VernacularTitle:多発脳梗塞，意識障害，機械弁Bentall術後弁輪部膿瘍を呈する活動期感染性心内膜炎に対して，ホモグラフト基部置換術を施行し良好な経過をたどった1例
- Author:
Hiroyuki KANEKO
1
;
Shogo SHIMADA
1
;
Minoru ONO
1
Author Information
- Keywords: infective endocarditis; annular abscess; cerebral infarction; disorders of consciousness; homograft
- From:Japanese Journal of Cardiovascular Surgery 2024;53(2):78-82
- CountryJapan
- Language:Japanese
- Abstract: A 24-year-old man was admitted due to fever for two days. He had undergone modified Bentall operation at the age of 18. Transthoracic echocardiography (TTE) showed no findings of infective endocarditis (IE), and he was treated with a course of antibiotics. On the next day, he suffered from aphasia and right hemiplegia, and computed tomography (CT) showed left cerebral infarction due to left middle cerebral artery embolism. The emergent endovascular reperfusion was done, but mild subarachnoid hemorrhage occurred. The following day, TTE showed vegetations and aortic annular abscess, and MSSA was confirmed by blood culture. He was transferred to our institution for surgical treatment for IE. High fever continued, and inflammatory response was recurrent, because the infection was not under control. In addition, multiple systemic thromboembolisms were revealed by contrast-enhanced CT. He recovered to the level of moving his limbs slightly, but he could not speak. We did aortic homograft root replacement and coronary bypass grafting 6 days after the cerebral infarction. His postoperative course was uneventful and he was transferred to rehabilitation hospital on postoperative day 31. He reintegrated into society without neurological complications, and there are no recurrent infections and have been no structural valve deteriorations of the homograft in 5 years.
