A surgical case of triple valve replacement for triple valve endocarditis with multiple vegetations
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CASE REPORT
A surgical case of triple valve replacement for triple valve endocarditis with multiple vegetations Hiroshi Furukawa1 · Takeshi Honda1 · Takahiko Yamasawa1 · Yuji Kanaoka1 · Kazuo Tanemoto1 Received: 12 July 2019 / Accepted: 4 December 2019 / Published online: 12 December 2019 © The Japanese Association for Thoracic Surgery 2019
Abstract A 68-year-old man with cerebral infarction and right hemiplegia was diagnosed with active infective endocarditis, and multiple large vegetations and more than moderate valve regurgitation by three different valves were detected using transthoracic echocardiography. An urgent surgical intervention was selected, and aortic and mitral valve replacements using bioprostheses were initially performed due to large vegetation on both these valves with valve cusp destruction. Residual severe regurgitation persisted despite tricuspid valve plasty; therefore, tricuspid valve replacement using a tissue valve was performed, and triple valve replacement was eventually accomplished without any serious hemodynamic compromise. The postoperative clinical course was fair and the patient was discharged after 3 months of inpatient strict management and cardiac rehabilitation. However, he died approximately 9 months after the initial surgery due to multiple organ failure. We herein presented a rare surgical case of triple valve replacement for triple valve endocarditis with multiple large vegetations. Keywords Active infective endocarditis · Triple valve endocarditis · Multiple vegetation · Triple valve replacement · Cerebral infarction
Introduction
Case
Active infective endocarditis (AIE) involving multiple valves is the most severe form of infective endocarditis, and the clinical and surgical management of AIE with multiple valvular involvement remains challenging in clinical settings [1]. Although the early introduction of surgical interventions for AIE is now clinically established based on previous novel findings [2] and current clinical guidelines [3, 4], surgical outcomes for multiple valvular involvement by AIE have been poor [1, 5]. We herein present a rare surgical case that required triple valve replacement for triple valve endocarditis with multiple vegetations and described a novel and unique analysis of triple valve endocarditis with multiple large vegetations.
A 68-year-old man developed right-side hemiplegia with muscle weakness and a speech disorder, and cerebral infarction was subsequently diagnosed based on the brain magnetic resonance imaging finding of a small high-intensity area on the left temporal lobe (Fig. 1). Multiple mobile vegetations on three valves (the aortic, mitral, and tricuspid valves) were detected by transthoracic echocardiography (TTE): 14 × 6 mm on the left coronary cusp of the aortic valve, 15 × 7 mm on the anterior and 9 × 9 mm on the posterior leaflet of the mitral valve, and 14 × 6 mm on the tricuspid valve with more than moderate regurgitation by each of the three valves, even patent foramen ovale (PFO) was not shown. An ileocecal tumor was s
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