| Surgical Treatment for Infective Endocarditis in a Case with Bicuspid Aortic Valve and Dilated Ascending Aorta |
(Department of Surgery and Department
of Surgical Pathology*, Faculty of Medical Sciences,
University of Fukui, Fukui, Japan)
| Sawaka Tanabe |
Kuniyoshi Tanaka |
Akio Ihaya |
| Koichi Morioka |
Takahiko Uesaka |
Wei Li |
| Narihisa Yamada |
Atsushi Takamori |
Mitsuteru Handa |
| Yoshiaki Imamura* |
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A 51-year-old man developed
a high fever with congestive heart failure after treatment
for his dental caries and was admitted to our hospital.
Transesophageal echocardiogram showed severe aortic regurgitation
with a bicuspid aortic valve where vegetation and perforation
was identified on its leaflets. Infective endocarditis
caused by Streptococcus constellatus was diagnosed by
blood culture. A computed tomography scan of the chest
showed enlargement of his ascending aorta with a maximum
diameter of 5.0cm. After treatment with antibiotics and
diuretics for 60 days, he underwent surgical treatment
for his aortic valve and ascending aorta. After excising
the diseased aortic leaflets with vegetation, a mechanical
prosthetic valve (Carbomedicus 23mm) was implanted. His
ascending aorta was also replaced separately with a woven
Dacron tube graft. There was an anomalous origin of the
right coronary artery which was detached from the ascending
aortic wall as a button and was implanted on the tube
graft. Histologically the aortic wall showed disappearance
of elastic fibers with myxomatous degeneration in the
media. Immunohistochemical staining also revealed that
matrix metalloproteinase-2 (MMP-2) was strongly expressed
in the aortic media. The postoperative course was uneventful
and he was discharged on the 37th postoperative day.
Jpn. J. Cardiovasc. Surg. 35: 183-187 (2006) |
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