| 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) |
|
