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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.
Abstract:
We successfully performed craniotomy and mitral valve replacement on a patient with bacterial endocarditis and ruptured intracranial aneurysm. A 15-year-old woman with fever and heart murmur was admitted to another hospital. Infective endocarditis and mitral valve regurgitation was diagnosed and treated with antibiotics. About one month after admission the patient suddenly showed severe headache and hemiparesis. Brain CT demonstrated intracerebral and subarachnoidal hemorrhage. The patient was unconscious when transferred to Mitsui Memorial Hospital where cerebral angiography showed anterior cerebral aneurysm and echocardiography showed mitral valve vegetation. We judged the necessary mitral valve replacement could be delayed until the aneurysm had been stabilized. We therefore began treatment using a different antibiotic but, in spite of this, 10 days later the aneurysm had enlarged dramatically. As conservative treatment was ineffective, a clipping operation was done to prevent re-rupture at the time of mitral valve replacement which could not be delayed much longer. 10 days later, cerebral 4 vessel study was done which showed no abnormality. Mitral valve replacement was then done and the patient was discharged in good health 64 days after the valve replacement.
Insights
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.