ABSTRACT
A 66-year-old man was given a diagnosis of urinary-tract infection and hospitalized for 2 weeks in another hospital in late August 2009. In late October of that year he was transferred to our hospital by ambulance because he was unable to ingest anything orally. Echocardiography showed that a vegetation of about 10 mm in maximum dimension was attached to the aortic valve, causing severe aortic stenosis and regurgitation. The patient's general condition was poor, and sepsis and disseminated intravascular coagulation syndrome developed. The next day, an urgent operation was performed, and an abscess was observed occupying one-third of the aortic valve annulus. The abscess was completely excised and the abscess cavity was covered with an equine pericardium patch. We then performed aortic valve replacement using a bioprosthetic valve followed by tricuspid valve annuloplasty. <i>Peptostreptococcus </i>spp. was detected in a culture of the abscess. Infective endocarditis due to <i>Peptostreptococcus </i>spp. is rare. There has been no recurrence of infection for 7 months postoperatively.
ABSTRACT
A 78-year-old woman who had had chest pain since 3 days previously, was given a diagnosis of acute myocardial infarction. Emergency coronary angiography revealed mid-left anterior descending artery and proximal right coronary artery lesions. Percutaneous coronary intervention was performed, and re-perfusion was successful. Cardiac tamponade was then diagnosed. Despite pericardial drainage, she remained in shock. After an intra-aortic balloon pump was established, an emergency operation was performed. On the operating table, her pulse disappeared. When thoracotomy was performed, a viscous hematoma was found in the pericardium. We found 3 ruptures in the left ventricular free wall, and hemorrhage. The diagnosis was a blow-out type left ventricular free wall rupture of the heart (LVFWR). We have used the patches-and-glue sutureless technique without cardiopulmonary support. This treatment for blow-type of LVFWR is rare.
ABSTRACT
The patient was a 58-year-old woman with untreated diabetes. She consulted a local doctor in May 2006 complaining of constipation that had persisted for 2 weeks, under gradually worsening abdominal pain. She was transferred to our hospital with a diagnosis of aortic aneurysm. Blood tests indicated high inflammatory response, and CT showed hematoma around the aorta from directly under the diaphragm to the level of superior mesenteric artery and influx of contrast medium into the hematoma. Control of the infection was first attempted with antibiotics, but eventually surgery was performed because the hematoma increased. The hematoma and aortic wall were completely excised from the local of the diaphragm to the level beneath the renal artery, with partial cardiopulmonary bypass and selective perfusion to abdominal branches, and anatomic reconstruction was performed with a synthetic graft and omental implantation. The hematoma was fetid and Citrobacter koseri was detected in culture. The patient was discharged after 4 weeks of antibiotic treatment, without complications and with satisfactory progress. At present, there has been no recurrence of infection in the 22 months since her discharge.