title: A patient in whom survival was achieved by acute-stage surgery for infective endocarditis complicated by a cerebral hemorrhage.
abstract: We report a patient who underwent mitral valve replacement despite acute-stage cerebral hemorrhage related to a complication of infective endocarditis (IE) and rupture of intracerebral mycotic aneurysm, achieving survival. The patient was a 24-year-old female. She consulted our hospital because of a fever and was diagnosed with IE and a cerebral hemorrhage. A blood culture test on admission revealed methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography revealed giant vegetation in the left atrium. Besides the management of an acute-stage cerebral hemorrhage, medical therapy for IE was performed. However, a severe infection was refractory, and mitral-regurgitation-related heart failure deteriorated. Despite acute-stage cerebral hemorrhage, mitral valve replacement was performed 10 days after admission because advanced disseminated intravascular coagulation syndrome made conservative management difficult. After surgery, neither exacerbation of cerebral symptoms nor recurrent IE was noted, and the patient was discharged.
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Hashimoto
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Hamawaki
authors.forename: Koji
authors.initials: K
authors.lastname: Hashizume
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
mesh_terms: D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000382:microbiology; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000382:microbiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents