Ruptured Mycotic Aneurysm and Cerebral Vasospasm in the Setting of Endocarditis and Heart Failure Requiring Cardiothoracic Surgery: Case Report and Literature Review.
BACKGROUND
Ruptured mycotic aneurysm in the setting of cardiac failure and cerebral vasospasm presents unique management challenges.


METHODS
A patient with a ruptured mycotic aneurysm with subarachnoid hemorrhage, cerebral vasospasm, and endocarditis with heart failure successfully underwent craniotomy, neuroendovascular treatment, and cardiopulmonary bypass for mitral valve replacement while in cerebral vasospasm. This case highlights clinical management strategies for a patient with a ruptured mycotic aneurysm, subarachnoid hemorrhage, cerebral vasospasm, endocarditis, and heart failure.


CONCLUSIONS
Open craniotomy, neuroendovascular treatment, and cardiac surgery strategies can be used when treating patients with ruptured mycotic aneurysms and cardiac failure. When the patient also has cerebral vasospasm, maintenance of mean arterial pressure is paramount.
Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA. Electronic address: Chih-Ta.Lin@uvmhealth.org.
Chih-Ta
CT
Lin
Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
Bruce
B
Tranmer
Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
Susan
S
Durham
Department of Radiology, University of Vermont, Burlington, Vermont, USA.
David
D
Johnson
Department of Anesthesiology, University of Vermont, Burlington, Vermont, USA.
Mark
M
Hamlin
Division of Cardiothoracic Surgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
R Morton
RM
Bolman
D000328:Adult; D000785:Aneurysm, Infected / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002315:Cardiopulmonary Bypass; D004696:Endocarditis / Q000150:complications / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D020301:Vasospasm, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery
Endocarditis; Heart failure; Mycotic aneurysm; Subarachnoid hemorrhage; Vasospasm