Surgical Management of Infective Endocarditis Complicated by Budd-Chiari Syndrome

Budd-Chiari syndrome (BCS) is a relatively rare comorbidity, particularly in patients undergoing cardiac surgery. The difficulty arises when we try to drain blood from the obstructed lower body circulation to establish extracorporeal circulation. Herein, we describe a patient who developed a persistent fever after undergoing neurosurgery for a head arteriovenous fistula, wherein blood cultures confirmed Staphylococcus aureus infection. The patient exhibited hyperbilirubinemia, hyperammonemia, and transient loss of consciousness. Transthoracic echocardiography showed moderate mitral regurgitation and 3 cm vegetation on the mitral valve. Imaging identified a thrombus in the right hepatic vein, stenosis of both the inferior vena cava and left hepatic vein, and esophagogastric and splenic varices. These findings led to establishing a diagnosis of infective endocarditis and BCS. The patient subsequently underwent mitral valve replacement with a mechanical valve. There are only a few case reports describing successful cardiac surgery in patients with BCS. Hence, we would like to report our surgical treatment of infective endocarditis complicated with BCS.