[Clinical results of open heart surgery within 2 weeks after cardiogenic embolic stroke]

Fourteen patients, 5 with infective valvular disease (IVD), 7 with non-infective valvular disease (NVD) and 3 with LA myxoma, underwent open heart surgery within 2 weeks after cardiogenic embolic stroke because of uncontrolled heart failure or recurrent embolism. Fifty percent of patients experienced a second embolism within 2 weeks of the initial stroke. Preoperative brain CT revealed no hemorrhagic infarction in all patients. However, in 3 of 5 patients with IVD, who had large brain infarction, one patient died from massive brain edema and two patients from severe brain hemorrhage. The other 2 patients with IVD, who had small infarction, and the remaining 7 patients with NVD and LA myxoma, even having large or small infarction, recovered without any complications. From these results, we concluded that 1) Open heart surgery within 2 weeks after initial stroke was safe in patients with no brain infarction and small non-hemorrhagic infarction, 2) Patients with IVD should be treated surgically before embolic stroke, because mortality rate was so high even in patients with non-hemorrhagic infarction.