초록접수 현황
| 16F-301 | 포스터 발표 |
Simultaneous Decompressive Craniectomy and Mitral Valve Replacement in Patient with Large Embolic Stroke Complicating Infective Endocarditis
Sang-Ho Cho¹, Dae Hyun Kim¹, Young Tae Kwak¹, Joo-Chul Park¹, Hyo Chul Yoon², Soo-Cheol Kim², Bum-Sik Kim²
¹Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea, ²Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
Background : Neurological complications are very frequent in patients with infective endocarditis (20–40%). Early cardiac surgical treatment is favored unless the neurological prognosis is judged to poor. The optimal timing depends on the type of neurological complication and the urgency of the valve operation. We report a case of simultaneous craniectomy and mitral valve replacement in patient with large embolic stroke complicating infective endocarditis (IE).
Methods : A 45-year-old man presented with a progressive lower back pain and a 20-day history of fever. On admission, empirical antibiotics were administered with clinical suspicion of liver abscess. However, he was transferred to the ICU and intubated with acute onset of pulmonary edema and mental status changes, 3 days after admission. Transthoracic echocardiography showed severe mitral regurgitation and large mobile vegetations on the anterior and posterior leaflets of the mitral valve. Blood cultures were positive for staphylococcus lugdunensis. Neurologic examination revealed that the patient was in semicoma. Brain CT scan showed massive cerebral infarction in the region of right middle cerebral artery, large edema, and severe midline shift.
Results : We decided to perform an emergency operation. Following to decompressive craniectomy of right fronto-parieto-temporal bone and duroplasty, an emergent mitral valve replacement with mechanical valve was successfully performed. After the operation for newly developed infectious spondylitis and neurological rehabilitation, he was discharged from the hospital on postoperative day 180. He was followed up without the recurrence of cardiovascular problem at an outpatient clinic for 8 months. The patient’s cognitive function returned to nearly normal and his left sided hemiparesis improved gradually.
Conclusion : In the absence of large prospective studies, the dicision and optimal timing of surgery is still discussed when stroke complicates IE. We suggest that after a stroke, surgery should not be delayed as long as coma is absent and cerebral hemorrhage has been excluded by brain CT.
Methods : A 45-year-old man presented with a progressive lower back pain and a 20-day history of fever. On admission, empirical antibiotics were administered with clinical suspicion of liver abscess. However, he was transferred to the ICU and intubated with acute onset of pulmonary edema and mental status changes, 3 days after admission. Transthoracic echocardiography showed severe mitral regurgitation and large mobile vegetations on the anterior and posterior leaflets of the mitral valve. Blood cultures were positive for staphylococcus lugdunensis. Neurologic examination revealed that the patient was in semicoma. Brain CT scan showed massive cerebral infarction in the region of right middle cerebral artery, large edema, and severe midline shift.
Results : We decided to perform an emergency operation. Following to decompressive craniectomy of right fronto-parieto-temporal bone and duroplasty, an emergent mitral valve replacement with mechanical valve was successfully performed. After the operation for newly developed infectious spondylitis and neurological rehabilitation, he was discharged from the hospital on postoperative day 180. He was followed up without the recurrence of cardiovascular problem at an outpatient clinic for 8 months. The patient’s cognitive function returned to nearly normal and his left sided hemiparesis improved gradually.
Conclusion : In the absence of large prospective studies, the dicision and optimal timing of surgery is still discussed when stroke complicates IE. We suggest that after a stroke, surgery should not be delayed as long as coma is absent and cerebral hemorrhage has been excluded by brain CT.
책임저자: Sang-Ho Cho
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
발표자: Sang-Ho Cho, E-mail : sinan75@khnmc.or.kr