A Case of Valve Repair for Active Infective Endocarditis Located in the Tricuspid Valve / 日本心臓血管外科学会雑誌

We report surgically treated case of tricuspid valve endocarditis in a non-drug addict. A 35-year-old man with no history of cardiac disease was admitted to our institution for persistent fever. His blood culture was positive for methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA). Echocardiography showed friable vegetations attached to the tricuspid valve with moderate tricuspid regurgitation. No other valves were affected. Chest computed tomography revealed multiple septic pulmonary emboli in both lungs. The infection was uncontrollable, so despite 6 weeks' of appropriate intravenous antibiotics therapy, he required surgery. Infected lesions had extended to parts of the septal leaflet and the posterior leaflet of the tricuspid valve. Valve repair with the resection-suture technique was performed. Half of the septal leaflet and a part of the posterior leaflet were excised with the vegetations, and the remaining septal leaflet was sutured to the posterior leaflet after annular plication without implanting an artificial ring. The postoperative course was uneventful, without further tricuspid regurgitation or stenosis. He was discharged after additional antibiotic administration for 4 weeks postoperatively, and he has remained free from endocarditis for over 1 year.

Coronary Artery Bypass Graft in a Patient Who Had Increased Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) Levels after Treatment with Heparin / 日本心臓血管外科学会雑誌

Cardiac surgery using heparin was performed in a patient in whom AST and ALT had been increased due to continuous drip infusion of heparin sodium. Here, we report postoperative changes in AST and ALT in the patient. The patient was a 59-year-old man with a past medical history of left internal carotid artery constriction and right cerebral infarction. Because of his previous medical history, continuous drip infusion of heparin was initiated upon discontinuation of preoperative antithrombotic agents. AST and ALT increased, but returned to normal levels when heparin was discontinued. Heparin was used to avoid aggravation of the symptoms, and bypass of 3 branches was performed with pulsation. Postoperative respiration and circulatory dynamics were stable, and the courses of AST and ALT were similar to those after general surgery, without abnormally high levels. Although the cause of heparin-induced increases in AST and ALT is unknown, the absence of postoperative increases may have been due to transient use at a high dose and neutralization by protamine.