[Infective Endocarditis of the Mitral Valve Complicated by Chronic Pyoderma of the Lower Abdomen Treated with...

A 45-year-old obese woman on long-term hemodialysis presented with fever and dizziness. Blood cultures revealed Streptococcus agalactiae, and echocardiography demonstrated large mobile vegetations on the mitral valve with preserved valve function. Chronic pyoderma involving the lower abdomen, groin, and vulva was considered the probable source of bacteremia. Because of severe obesity, multiple comorbidities, and extensive skin infection in the inguinal region, minimally invasive cardiac surgery (MICS) via right thoracotomy was performed, avoiding median sternotomy and femoral cannulation. Cardiopulmonary bypass was established using right axillary artery perfusion and jugular and inferior vena cava drainage. Vegetations were successfully removed without mitral valve repair. The postoperative course was uneventful, and no recurrence of infection was observed during two years of follow-up. This case highlights the feasibility of alternative cannulation strategies in MICS for infective endocarditis complicated by extensive skin disease.