Mitral valve surgery with surgical embolectomy for mitral valve endocarditis complicated by septic coronary embolism

• Published in: European journal of cardio-thoracic surgery 2008-01, Vol.33 (1), p.116-118
• Main Authors: Baek, Man-Jong, Kim, Hyun Koo, Yu, Cheol Woong, Na, Chan-Young
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Adult; Biological and medical sciences; Cardiology. Vascular system; Coronary embolism; Coronary heart disease; Echocardiography; Embolectomy; Embolectomy - methods; Embolism - complications; Embolism - pathology; Endocardial and cardiac valvular diseases; Endocarditis; Endocarditis, Bacterial - enzymology; Endocarditis, Bacterial - surgery; Heart; Humans; Male; Medical sciences; Mitral Valve - enzymology; Mitral Valve - pathology; Mitral Valve - surgery; Myocardial Infarction - enzymology; Myocardial Infarction - surgery; Pneumology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2007.09.024

Acute myocardial infarction (AMI) complicated by septic coronary embolism due to active infective endocarditis is rare but usually fatal. We report a case of successful mitral valve surgery with surgical embolectomy in a 27-year-old man with an AMI complicated by septic coronary embolism due to mitral valve endocarditis. A chest radiograph revealed cardiomegaly and marked pulmonary edema. A transthoracic echocardiogram disclosed severe mitral regurgitation with highly mobile vegetations and hypokinesia of the left ventricular apex. The electrocardiographic findings of ST segment elevation in leads V2-4 and elevated cardiac enzyme levels were strongly suggestive of an acute anterolateral AMI. Nevertheless, emergent cardiac surgery was needed without selective coronary angiography because of intractable heart failure and life-threatening ventricular tachyarrhythmia requiring cardiopulmonary resuscitation. A total occlusion of the distal left anterior descending artery caused by embolic vegetation and thrombus, which was incidentally detected intraoperatively, was successfully recanalized by surgical embolectomy and thrombectomy using a direct coronary incision. The mitral valve endocarditis was managed with wide debridement and mechanical valve replacement. Three years after the surgery a follow-up echocardiogram showed no abnormalities of the regional wall, motion in the left ventricle and the patient is living an active life without any complications.