A Case of Pneumococcal Endocarditis Complicating Overwhelming Postsplenectomy Infection / 日本心臓血管外科学会雑誌

Postsplenectomy patients are susceptible to severe infections due to encapsulated bacteria such as Streptococcus pneumoniae and Haemophilus influenzae and this condition is widely known as Overwhelming Postsplenectomy Infection (OPSI). OPSI is relatively rare in conditions with rapid progression and high mortality rates. There are very few reports of infective endocarditis from OPSI. A 40-year-old man who underwent splenectomy 20 years before was transported to the emergency room. He had severe heart failure and multiple cerebral embolisms. The echocardiography showed vegetation on the aortic valve and severe regurgitation due to perforation of the non-coronary cusp. We performed aortic valve replacement on an emergent basis. In infected patients after splenectomy, early diagnosis and prompt treatment are desired because of the possibility of rapid progression of sepsis in encapsulated bacteria and poor prognosis.

A Case of Purulent Pericarditis Caused by Baceteroides fragilis Successfully Treated with Pericardiotomy Using Left Small Thoracotomy / 日本心臓血管外科学会雑誌

A 70-year-old woman who was bedridden because of right hemiplegia attributable to a history of cerebral hemorrhage underwent surgical thrombectomy for pulmonary embolism four years previously. Symptoms of heart failure appeared one year previously, and she was diagnosed with constrictive pericarditis and had been treated with medication by a previous doctor. In the current situation, she visited the previous doctor with the chief complaint of fever, and pericardial effusion was observed on echocardiography. Cardiac tamponade was suspected and she was transferred to our hospital. She was then diagnosed with purulent pericarditis because purulent fluid was observed during pericardiocentesis drainage. Bacteroides fragilis was isolated from the culture of the abscess. The abscess was resistant to conservative antibiotic therapy ; therefore, we performed a pericardiotomy with a left small thoracotomy. The pleural effusion was found to be negative for culture and the patient exhibited a good postoperative course. Purulent pericarditis is refractory with poor prognosis. An appropriate surgical procedure must be chosen considering the patient's activities of daily living. Here, we report a surgical case wherein we chose the left thoracotomy approach and achieved positive results.