Mitral valve surgery with surgical embolectomy for mitral valve endocarditis complicated by septic coronary embolism.
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.
Baek
Man-Jong
MJ
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
Kim
Hyun Koo
HK
Yu
Cheol Woong
CW
Na
Chan-Young
CY
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