A Surgical Case of Infective Endocarditis with Intraoperative Intracranial Hemorrhages after Antibiotic Therapy for 6 Weeks

Hiroki Kato

Ryuta Seguchi

Teruaki Ushijima and Go Watanabe

（Department of Cardiovascular Surgery, International University Hospital Welfare, Mita Hospital, Tokyo, Japan）

A case of intracranial hemorrhage during valve surgery for infective endocarditis is reported. The patient was a 40-year-old man whose chief complaint was fever of unknown origin. Echocardiography demonstrated severe mitral regurgitation with vegetations. A blood culture demonstrated Streptococcus salivarius. He was treated with penicillin G and gentamicin for 6 weeks. Magnetic resonance imaging（MRI）was performed 10 days before surgery, but acute infarction, hemorrhage, or mycotic aneurysm were not observed. Mitral valve replacement was performed with a mechanical valve. Postoperatively, the patient had hemiplegia. Hemorrhage was visible in the right thalamus and left cerebellum on computed tomography. Ventricular drainage and removal of the cerebellar hematoma were performed the next day. These results suggest that to avoid cerebral complications during cardiac surgery for infective endocarditis, strict activated clotting time control and MRI just before surgery appear to be necessary.

　

Jpn. J. Cardiovasc. Surg. 43:88-91（2014）

Keywords：infective endocarditis;intracranial hemorrhage