title: Successful surgical treatment with mitral valve replacement and coronary embolectomy in a patient with active infective endocarditis complicated by multiple septic embolisms involving cerebral arteries and the right coronary artery.
abstract: The proper management of a patient with active infective endocarditis (IE) remains to be determined, especially when his or her condition is complicated with intracranial mycotic aneurysm. Here we present a 46-year-old company employee hospitalized with a subarachnoid hemorrhage caused by a ruptured mycotic aneurysm. Cardiac echography showed a verruca on the posterior mitral cusp and leaflet destruction, resulting in severe valvular regurgitation (determined pathogen was α-streptococcus). High-dose antibiotic infusion and restriction of physical activity to prevent heart failure were combined with emergency craniotomy drainage and coiling of the necks of two cerebral mycotic aneurysms. After 2 months of conservative therapy for IE, he suddenly collapsed with hypotension and bradycardia because of embolic occlusion of the proximal right coronary artery (RCA). An emergent operation was carried out to remove the emboli in the RCA and to replace the mitral valve with a mechanical prosthesis. The postoperative course was uneventful. Although disturbances of spatial recognition and manual dexterity remained, he was able to walk and talk. After postoperative sufficient-duration antibiotic therapy, which lasted 20 days, he was transferred to a rehabilitation center.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, St. Luke's International Hospital, 9-1 Akashicho Chuo-Ku, Tokyo, 104-8560, Japan. manayama@luke.or.jp
authors.forename: Manabu
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Sunao
authors.initials: S
authors.lastname: Watanabe
authors.forename: Kohei
authors.initials: K
authors.lastname: Abe
authors.forename: Michiko
authors.initials: M
authors.lastname: Uenishi
authors.forename: Kohei
authors.initials: K
authors.lastname: Kawazoe
mesh_terms: D017023:Coronary Angiography; D003331:Coronary Vessels; D017128:Embolectomy; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D004696:Endocarditis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D014463:Ultrasonography