| Aortic Sepsis with Aorto-Pulmonary
Fistula Following Infective Endocarditis (IE) |
(Department of Cardiovascular Surgery, The Cardiovascular
Center, Kyoto Katsura Hospital, Kyoto, Japan)
| Hideki Ozawa |
Hisao Kurihara |
Hiroshi Furukawa |
| Masahiro Daimon |
Takahiro Katsumata |
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A59-year-old man presented with
sporadic febrile illness. Echocardiography showed multiple vegetations
on the mitral valve. Blood culture yielded Viridans streptococci.
Mitral valve replacement was performed, and a high dose of penicillin
G sodium (24million U/day) was administrated for 4weeks postoperatively.
On the 28th postoperative day, the patient developed severe back
pain and bloody sputum. Chest CT showed a false aneurysm of the
distal aortic arch (5.5cm). The patient was placed on cardiopulmonary
bypass with the arterial return in the mid-aortic arch. The aneurysm
was resected and replaced with a Dacron tube during deep hypothermic
circulatory arrest. The aortic wall was interspersed with mobile
nodules that appeared to be colonized. The aorto-pulmonary fistula
was directly closed. The whole procedure was carried out through
the 4th intercostal space. The tissue culture was negative but
histopathology suggested a persistent inflammatory process. Excavating
aortic sepsis may occur following active endocarditis. Even if
cardiac infection is controlled, continuous search should be
undertaken for possible dilatation in remote parts of the arterial
system.
Jpn. J. Cardiovasc. Surg. 32：161 -163 (2003) |
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