A Case of Ruptured Mycotic Aneurysm of the Superior Mesenteric Artery Requiring a Bentall Procedure and Mitral Valvuloplasty

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  • INOUE Maki
    Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences
  • KADONO Jun
    Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences
  • HAYASHI Sadao
    Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences
  • TASAKI Takashi
    Department of Human Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences
  • MOTOI Syunsuke
    Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences
  • IMOTO Yutaka
    Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences

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Other Title
  • 細菌性上腸間膜動脈瘤破裂後にBentall手術および僧帽弁形成術を施行した1例
  • 症例 細菌性上腸間膜動脈瘤破裂後にBentall手術および僧帽弁形成術を施行した1例
  • ショウレイ サイキンセイ ジョウチョウカンマク ドウミャクリュウ ハレツ ゴ ニ Bentall シュジュツ オヨビ ソウボウベン ケイセイジュツ オ シコウ シタ 1レイ

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Abstract

A 59-year-old man was diagnosed with infective endocarditis (IE) complicated by severe aortic regurgitation and vegetation on the mitral valve. Although antibiotic administration and treatment of periodontal disease controlled the IE, he went into shock due to rupture of a mycotic aneurysm of the superior mesenteric artery. Transarterial embolization (TAE) maintained hemostasis, but ischemia of the ileum was suspected 90 minutes after TAE. Both the ischemic event and the risk of worsening infection in the aneurysm led us to perform emergency surgery. Laparotomy revealed an ischemic ileum with a massive hematoma in the mesentery. The coils placed during TAE aided detection of the aneurysm. Partial ilectomy, including the aneurysm, was performed under stable hemodynamic conditions. The patient successfully underwent a Bentall procedure and mitral valvuloplasty 92 days after the preceding surgery. TAE could be a useful technique for both hemostasis and subsequent surgery in cases of ruptured mycotic aneurysm. However, the fact that TAE can develop complications such as ischemic events must be taken into consideration.

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