A Case of Acute Arterial Occlusion of the Lower Extremity Caused by Huge Vegetation of Prosthetic Valve Endocarditis

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  • Yamashita Kizuku
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
  • Fujita Tomoyuki
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
  • Hata Hiroki
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
  • Shimahara Yusuke
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
  • Sato Shunsuke
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
  • Kobayashi Junjiro
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center

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Other Title
  • 人工弁感染性心内膜炎の巨大疣贅により急性下肢動脈閉塞をきたした1例

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Abstract

A 79-year-old woman with prosthetic valve endocarditis (PVE) on aortic position underwent re-aortic valve replacement. Although emergency operation was indicated due to huge vegetation over 20 mm in diameter attached to the prosthesis shown by preoperative transesophageal echocardiography, intraoperative transesophageal echocardiography showed disappearance of the vegetation. The prosthesis was carefully removed and replaced by a new bioprosthesis, though only small vegetation was observed on the removed prosthesis. Sudden blue toe 11 h after the operation and diminished pulse on right pedal artery suggested an acute arterial occlusion of a right lower extremity, requiring an emergency thrombectomy. Pathology diagnosed bacterial embolus with fresh thrombus that was considered apart from the prosthesis at the time of operation.

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