[Surgical treatment of infective endocarditis associated with cerebral mycotic aneurysm]

We experienced two cases of infective endocarditis associated with cerebral mycotic aneurysm. Case 1: 58 year-old man underwent emergency aortic and mitral valve replacement due to active infective endocarditis and congestive heart failure diagnosed by transesophageal echocardiography. After the operation, he did not wake up and his bilateral pupils were dilated. Computed tomography demonstrated massive intracranial hemorrhage and severe brain edema. He died from multiple organ failure 22th postoperative day. Rupture of cerebral mycotic aneurysm was strongly suspected. Case 2: 56 year-old man was admitted with severe headache and high grade fever. Computed tomography demonstrated intracranial hemorrhage. Cerebral mycotic aneurysm was detected at left distal middle cerebral artery by cerebral angiography. Infective endocarditis and mitral regurgitation were also diagnosed by echocardiography. He underwent cerebral mycotic aneurysmectomy after intensive antibiotics therapy, followed by successful mitral valve replacement. We review the literatures and discuss the problems of surgical management of infective endocarditis with cerebral mycotic aneurysm.