ABSTRACT
The case was a 77-year-old man. He had dizziness and dysphagia for 2 years, and underwent detailed screening at the internal medicine department for general malaise and bloody sputum. He was hospitalized for aspiration pneumonia due to dysphagia of unknown origin. This time, he visited a local doctor with palpitations and shortness of breath. Echocardiography indicated a left atrial tumor involving the mitral valve and arrhythmia. Emergency surgery was performed to remove the left atrial myxoma and close the patch at our hospital's cardiovascular surgery department. After the excision, swallowing function was restored, and the patient was diagnosed with postoperative Ortner's syndrome. We report a case where echocardiography was considered important as a detailed investigation of the cause of swallowing dysfunction and dizziness.
ABSTRACT
A 62-year-old man was admitted to our hospital complaining of high fever and clouding of consciousness. His initial diagnosis was infective vegetative endocarditis involving the mitral valve with multiple hemorrhagic cerebral infarctions. We chose medical therapy because of cerebral hemorrhage and scheduled surgery two weeks after the hospital admission. During medical therapy, echocardiography showed rapid growth of the vegetation on the 6th hospital day, suggesting cardiac tumor. Surgery was performed on the 16th hospital day. We found an infected myxoma with vegetation on the mitral valve and annular abscess extending to the left ventricle. The myxoma was resected and the abscess carefully debrided. We replaced the mitral valve after the mitral annulus was reinforced with autologous pericardium. The patient underwent antibiotic therapy for 6 weeks after the surgery. He was discharged from the hospital with no sign of recurrence.
ABSTRACT
A 77-year-old man underwent aortic valve replacement with a Carpentier-Edwards Pericardial Magna (19 mm) for aortic stenosis. He presented with a low grade fever and congestive heart failure 6 months after the initial valve replacement. <i>Staphylococcus aureus </i>was detected in blood culture, and peri-valvular leakage was revealed by echocardiography. Prosthetic valve endocarditis was diagnosed and underwent re-aortic valve replacement with Medtronic Mosaic 21 mm bioprothesis. Six months after the re-do operation, perivalvular leakage was newly observed between the right and non-coronary cusps, which was opposite to endocarditis affected cusps. The peri-valvular leakage was considered to have resulted from the fragile valve annulus because he did not have fever, and repeated blood culture showed no bacterial growth. We performed a third surgery and repaired the leakage by adding sutures through the right atrium and the interventricular septum to avoid directly suturing the fragile annulus. The post-operative course was uncomplicated, and no sign of endocarditis nor perivalvular leakage was observed during 9-months of observation. It is considered that the aortic valve fixation sutures through the right atrium and inter-ventricular septum are useful alternatives for fragile aortic annulus after prosthetic valve endocarditis.