樋口 義郎

A 59-year-old male who had undergone aortic and mitral valve replacement with Starr-Edwards ball valves 27 years ago was admitted to our hospital for hemolytic anemia and heart failure. Echocardiography revealed prosthetic valve failure with a high-pressure gradient and small effective orifice area. The Starr-Edwards ball valves were successfully replaced with bileaflet mechanical valves. The explanted valves revealed no structural abnormalities.

Purpose: Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T2- weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes. Methods: Eighteen patients were referred to our department for native valve IE during 2006-2010. Urgent surgery was indicated in cases of hemodynamic failure resulting from valve destruction, refractory sepsis, and mobile vegetations measuring &gt 10 mm. For these patients, we performed preoperative MRI and MRA. Results: Males comprised 67% of the subjects, with average age 53 ± 15 years. No clinical evidence of acute stroke was noted. Of the 18 patients, urgent surgery was indicated in 15 of these, 10 (67%) showed a brain lesion related to IE: 6 patients had acute or subacute brain infarctions, 2 patients had brain infarction with brain abscess, and 2 patients had hemorrhagic brain infarction and so did not undergo urgent surgery. Thus, 13 patients underwent urgent valve surgery. Among the 5 patients who did not undergo urgent surgery, 4 patients later underwent valve surgery for healed IE. No hospital deaths or neurological complications occurred. Conclusion: MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes. © 2011 The Japanese Association for Thoracic Surgery.