Aortic Valve Replacement and CABG for Aortic Stenosis and Unstable Angina Combined with Active Infective Endocarditis

Naoto Miyagi Hiroyuki Tanaka Mikiko Murakami
Koso Egi Satoru Hasegawa Makoto Sunamori

(Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan)

A 59-year-old man who had been treated medically for aortic stenosis and angina pectoris was hospitalized due to a high fever. He was treated immediately by intravenous infusion of antibiotics. Blood culture was positive for α-streptococcus. Echocardiography revealed severe aortic stenosis with vegetation on the aortic valve and minimal aortic regurgitation. The peak aortic pressure gradient was 80 mmHg. The patient developed chest pain at rest and showed ischemic ST-segment depression on the electrocardiogram obtained after admission. Coronary angiography(CAG)was performed to assess the extent of coronary artery disease, and it showed 90% stenosis of the right coronary artery(RCA)and 75% stenosis of the circumflex branch(Cx). Both fever and angina pectoris were so resistant to maximal medical treatment that the patient was referred to our hospital for urgent surgical treatment. During surgery, a large vegetation was noted on the aortic valve, which was calcified, and a destructive ring abscess was observed around the coronary cusp. Aortic valve replacement(SJM-19 mm)was performed after complete debridement of the abscess and repair of the resulting aorto-ventricular discontinuity. Double coronary bypass saphenous vein grafting to RCA and Cx was performed. The patient recovered without incident and was discharged 4 weeks after surgery. 
  Jpn. J. Cardiovasc. Surg. 31:136-138(2002)