A Surgical Case of Infective Endocarditis with Intraoperative Intracranial Hemorrhages after Antibiotic Therapy for 6 Weeks

DOI
  • Kato Hiroki
    Department of Cardiovascular Surgery, International University Hospital Welfare, Mita Hospital
  • Seguchi Ryuta
    Department of Cardiovascular Surgery, International University Hospital Welfare, Mita Hospital
  • Ushijima Teruaki
    Department of Cardiovascular Surgery, International University Hospital Welfare, Mita Hospital
  • Watanabe Go
    Department of Cardiovascular Surgery, International University Hospital Welfare, Mita Hospital

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  • 6週間の抗生剤治療後の手術にて術中脳出血をきたした感染性心内膜炎の1例

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A case of intracranial hemorrhage during valve surgery for infective endocarditis is reported. The patient was a 40-year-old man whose chief complaint was fever of unknown origin. Echocardiography demonstrated severe mitral regurgitation with vegetations. A blood culture demonstrated Streptococcus salivarius. He was treated with penicillin G and gentamicin for 6 weeks. Magnetic resonance imaging (MRI) was performed 10 days before surgery, but acute infarction, hemorrhage, or mycotic aneurysm were not observed. Mitral valve replacement was performed with a mechanical valve. Postoperatively, the patient had hemiplegia. Hemorrhage was visible in the right thalamus and left cerebellum on computed tomography. Ventricular drainage and removal of the cerebellar hematoma were performed the next day. These results suggest that to avoid cerebral complications during cardiac surgery for infective endocarditis, strict activated clotting time control and MRI just before surgery appear to be necessary.

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