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[A case report of early valve replacement surgery in infective endocarditis with mycotic cerebral aneurysm]
Abstract:
Mycotic cerebral aneurysm is a relatively infrequent complication of infective endocarditis. However, rupture and intra-cranial hemorrhage involves so high a mortality that few patients can be saved from this condition. We reported a 22-year-old woman with mitral regurgitation and ruptured mycotic cerebral aneurysm caused by infective endocarditis. Vegetation floating between the left atrium and the ventricle was observed by UCG. It was difficult to decide which operation should be done first, valve replacement or excision of cerebral aneurysm. To avoid further intracerebral bleeding caused by anticoagulant therapy connected with cardiotomy, the cerebral aneurysm was excised prior to the valve replacement. Mitral valve was replaced with a Björk-Shiley prosthetic valve 48 hours after the craniotomy. The postoperative course was uneventful and no neurological deficit was found. This report indicates that valve replacement surgery can be successfully performed only 48 hours after craniotomy without any bleeding complications.
Insights
Mycotic cerebral aneurysms from infective endocarditis are dangerous. This case shows successful surgical treatment of a ruptured cerebral aneurysm followed by valve replacement 48 hours later, with no complications.
Area of Science:
- Cardiology
- Neurosurgery
- Infectious Diseases
Background:
- Mycotic cerebral aneurysms are rare but life-threatening complications of infective endocarditis.
- Rupture leads to high mortality due to intracranial hemorrhage.
- Co-existing conditions like mitral regurgitation complicate treatment decisions.
Observation:
- A 22-year-old woman presented with mitral regurgitation and a ruptured mycotic cerebral aneurysm secondary to infective endocarditis.
- Echocardiography (UCG) revealed vegetation between the left atrium and ventricle.
- The critical decision involved prioritizing either valve replacement or cerebral aneurysm excision.
Findings:
- The patient underwent successful excision of the cerebral aneurysm first to prevent bleeding complications from anticoagulation therapy during cardiotomy.
- Mitral valve replacement with a Björk-Shiley prosthetic valve was performed 48 hours after the craniotomy.
- The patient experienced an uneventful postoperative recovery with no neurological deficits.
Implications:
- This case demonstrates the feasibility of performing valve replacement surgery as early as 48 hours after craniotomy for mycotic cerebral aneurysm excision.
- The staged surgical approach can be safe and effective in managing complex cases of infective endocarditis with associated cerebral aneurysms.
- Early intervention and careful surgical planning are crucial for improving outcomes in patients with this rare but severe condition.