Infective Endocarditis with an Infectious Cerebral Aneurysm Rupture and an Acute Myocardial Infarction / 日本心臓血管外科学会雑誌

A 56-year-old woman was referred to our hospital due to anorexia. An echocardiogram demonstrated severe mitral valve regurgitation and vegetation located on the valve. We diagnosed infective endocarditis and started to treat with antibiotics. During antibiotics treatment, cerebral hemorrhage was caused by rupture of an infectious cerebral aneurysm. She was treated by surgical operation. Waiting for cardiac surgery, she had sudden chest pain. Electrocardiogram examination demonstrated an anterior acute myocardial infarction. Emergency coronary angiogram revealed complete obstruction of the left anterior descending coronary artery. She was successfully treated with thrombus aspiration using a catheter device and stenting. However, she was in cardiogenic shock and her blood pressure could not be maintained with catecholamine and IABP. We performed emergency mitral valve replacement. After surgery, the circulation dynamics improved and she was discharged from the hospital.

A Case of Spontaneous Ascending Aortic Rupture Which Was Difficult to Distinguish from Stanford Type A Acute Aortic Dissection / 日本心臓血管外科学会雑誌

A 77-year-old man was admitted to our hospital with sudden anterior chest pain followed by shock. An echocardiography showed enlargement of the sinus of Valsalva, severe aortic regurgitation and pericardial effusion. A chest CT scan showed a crescent sign in the ascending aorta. The preoperative diagnosis was a ruptured Stanford type A acute aortic dissection and an emergency operation was performed. In the operative findings, a bloody pericardial effusion, a hematoma around the ascending aorta and a tear (less than 2 cm) of the ascending aorta just distal area of the sinotubular junction were observed. In this case, since the enlargement of the sinus of Valsalva and the severe aortic regurgitation were observed, we performed a replacement of the ascending aorta including the aortic root with an artificial vascular graft (J graft 28 mm) and a biological valve (Magna EASE 25 mm). The pathologic examinations revealed a rupture of ascending aorta in all layers and a hematoma outside the adventitia. The pathologic diagnosis showed a spontaneous aortic rupture. The postoperative course was good and he was discharged 1 month after the surgery. A spontaneous aortic rupture is defined as an aortic rupture without a trauma, an aneurysm or a dissection. It is rare but fatal and it is said that surgical treatment is necessary. We report a successful surgical case of the spontaneous aortic rupture which was difficult to distinguish from a Stanford A type acute aortic dissection.