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[Valve replacement in infective endocarditis with mycotic aneurysm]
K Yoshida1, Y Wanibuchi, T Kanda
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
|October 1, 1990
Summary
This case study details a successful craniotomy and mitral valve replacement in a patient with bacterial endocarditis and a ruptured intracranial aneurysm. The complex procedure highlights effective management of critical cardiovascular and neurological conditions.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Infectious Diseases
Background:
- A 15-year-old female presented with fever and heart murmur, diagnosed with infective endocarditis and mitral valve regurgitation.
- Initial antibiotic treatment was administered at an outside hospital.
Observation:
- The patient developed sudden severe headache and hemiparesis, indicative of intracerebral and subarachnoidal hemorrhage.
- Brain CT confirmed hemorrhage; cerebral angiography revealed an anterior cerebral aneurysm; echocardiography showed mitral valve vegetation.
Findings:
- A staged approach was employed, initially clipping the anterior cerebral aneurysm to prevent re-rupture during subsequent mitral valve replacement.
- Post-aneurysm clipping, cerebral angiography showed no abnormalities, allowing for safe mitral valve replacement.
- The patient recovered well and was discharged 64 days after valve replacement.
Implications:
- This case demonstrates the successful management of concurrent bacterial endocarditis with intracranial aneurysm rupture.
- A staged surgical intervention is feasible and effective for patients with complex cardiovascular and neurological emergencies.
- Multidisciplinary collaboration is crucial for optimizing outcomes in critically ill patients requiring complex surgical interventions.