title: [Intra-atrial vegetation removal in a 14-month-old boy complicated with postoperative infective endocarditis and left middle cerebral artery embolism].
abstract: We report a case of the intra-atrial vegetation removal under cardiopulmonary bypass (CPB) in a case complicated with left middle cerebral artery embolism caused by postoperative infective endocarditis. The patient was a 14-month-old boy. Two months after intracardiac repair for a complex congenital heart disease, he presented with low-grade fever and was placed on oral antibiotics. A month later an echocardiography revealed 2 vegetations on the tricuspid valve. Although the vegetations became smaller with intravenous antibiotics, right hemiplegia was noted 5 weeks later. Brain CT and MR-angiography demonstrated left middle cerebral artery embolism. For fear of another embolism caused by a remaining movable vegetation on the tricuspid valve, intra-atrial vegetation removal under CPB was performed 5 days after cerebral infarction. Intraoperative transesophageal echocardiography was utilized to locate the vegetation and confirm its removal. His postoperative course was uneventful without a recurrence of cerebral infarction or bleeding. He was weaned from the ventilator on postoperative day (POD) 1, started to move the right extremities on POD 5 and was discharged home on POD 66.
authors.affiliation: Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal & Child Health, Izumi 594-1101.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Miyagawa
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Kagawa
authors.forename: Keiko
authors.initials: K
authors.lastname: Kinouchi
mesh_terms: D002315:Cardiopulmonary Bypass; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000601:surgery*; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery