A Patient in Whom Survival Was Achieved by Acute-Stage Surgery for Infective Endocarditis Complicated by a Cerebral Hemorrhage

Wataru Hashimoto, MD,1 Masayoshi Hamawaki, MD,2 Koji Hashizume, MD,1 and Kiyoyuki Eishi, MD1

We report a patient who underwent mitral valve replacement despite acute-stage cerebral hemorrhage related to a complication of infective endocarditis (IE) and rupture of intracerebral mycotic aneurysm, achieving survival. The patient was a 24-year-old female. She consulted our hospital because of a fever and was diagnosed with IE and a cerebral hemorrhage. A blood culture test on admission revealed methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography revealed giant vegetation in the left atrium. Besides the management of an acute-stage cerebral hemorrhage, medical therapy for IE was performed. However, a severe infection was refractory, and mitral-regurgitation-related heart failure deteriorated. Despite acute-stage cerebral hemorrhage, mitral valve replacement was performed 10 days after admission because advanced disseminated intravascular coagulation syndrome made conservative management difficult. After surgery, neither exacerbation of cerebral symptoms nor recurrent IE was noted, and the patient was discharged. (Ann Thorac Cardiovasc Surg 2009; 15: 257-260)

Key words: infective endocarditis, cerebral hemorrhage, intracerebral mycotic aneurysm, cardiac surgery

1Department of Cardiovascular Surgery, Nagasaki University; and 2Department of Cardiovascular Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan

Received July 23, 2008; accepted for publication August 6, 2008
Address reprint requests to Wataru Hashimoto, MD: Department of Cardiovascular Surgery, Nagasaki University, 1–7–1 Sakamoto, Nagasaki 852–8501, Japan.