title: Mitral valve surgery with surgical embolectomy for mitral valve endocarditis complicated by septic coronary embolism.
abstract: Acute myocardial infarction (AMI) complicated by septic coronary embolism due to active infective endocarditis is rare but usually fatal. We report a case of successful mitral valve surgery with surgical embolectomy in a 27-year-old man with an AMI complicated by septic coronary embolism due to mitral valve endocarditis. A chest radiograph revealed cardiomegaly and marked pulmonary edema. A transthoracic echocardiogram disclosed severe mitral regurgitation with highly mobile vegetations and hypokinesia of the left ventricular apex. The electrocardiographic findings of ST segment elevation in leads V2-4 and elevated cardiac enzyme levels were strongly suggestive of an acute anterolateral AMI. Nevertheless, emergent cardiac surgery was needed without selective coronary angiography because of intractable heart failure and life-threatening ventricular tachyarrhythmia requiring cardiopulmonary resuscitation. A total occlusion of the distal left anterior descending artery caused by embolic vegetation and thrombus, which was incidentally detected intraoperatively, was successfully recanalized by surgical embolectomy and thrombectomy using a direct coronary incision. The mitral valve endocarditis was managed with wide debridement and mechanical valve replacement. Three years after the surgery a follow-up echocardiogram showed no abnormalities of the regional wall, motion in the left ventricle and the patient is living an active life without any complications.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Guro Hospital, College of Medicine, Korea University, 80 Guro-dong, Guro-ku, Seoul 152-703, Republic of Korea. mdmjbaek@korea.ac.kr
authors.forename: Man-Jong
authors.initials: MJ
authors.lastname: Baek
authors.forename: Hyun Koo
authors.initials: HK
authors.lastname: Kim
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.forename: Chan-Young
authors.initials: CY
authors.lastname: Na
mesh_terms: D000328:Adult; D004452:Echocardiography; D017128:Embolectomy / Q000379:methods; D004617:Embolism / Q000150:complications / Q000473:pathology; D004697:Endocarditis, Bacterial / Q000201:enzymology / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D009203:Myocardial Infarction / Q000201:enzymology / Q000601:surgery*; D016896:Treatment Outcome