Infected Abdominal Aortic Aneurysm Successfully Treated With Endovascular Aortic Repair and Antibiotics: A Case Report.

Surgical treatment of infected aneurysms is problematic due to their high complication and mortality rates. Infected aortic aneurysms are at high risk of rupture and should be operated on as soon as possible after diagnosis. A 72-year-old female patient with a medical history of diabetes mellitus, hyperlipidemia, and hypertension presented with a fever of 38°C and back pain, without any apparent cause, in 2021. Her C-reactive protein (CRP) level increased to 20 mg/dL. Further evaluation with contrast-enhanced computed tomography (CT) revealed a low-density area with air pockets surrounding the abdominal aorta. The patient was diagnosed with native abdominal aortic infection and transferred to our hospital for treatment. The next day, endovascular aortic repair (EVAR) was performed using an Endurant stent graft (161682). Postoperatively, the patient was treated with antibiotics, and subsequently, blood infection was alleviated. Moreover, the CRP levels normalized. Follow-up contrast-enhanced CT showed resolution of the air pockets surrounding the abdominal aorta. The patient was discharged home on postoperative day 33. During her three-year follow-up as an outpatient, no recurrence of the infection was detected. While open surgical repair with prosthetic graft replacement is often the preferred treatment for infected abdominal aortic aneurysms, in select cases, as demonstrated by our patient, EVAR can be employed to prevent rupture, followed by antibiotic therapy to achieve infection control.

Long-term outcomes of primary surgical repair for communicating DeBakey IIIb chronic dissecting aortic aneurysm.

Objective: This study aimed to evaluate the long-term outcomes of surgical strategies for communicating DeBakey IIIb chronic dissecting aortic aneurysm, considering the optimal primary surgical repair to prevent aortic events. Methods: From 2002 to 2021, 101 patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm who underwent surgical repair were categorized based on the primary surgical repair: 1-stage repair of thoracoabdominal aortic aneurysm (TAAAR) (n = 22) or staged repair, such as descending thoracic aneurysm repair (DTAR) (n = 43) or total arch replacement with elephant trunk implantation (TARET) (n = 25), and thoracic endovascular aortic repair (TEVAR) (n = 11). Early and late postoperative outcomes were compared among the groups. Results: Early outcomes for TAAAR, DTAR, TARET, and TEVAR were associated with the incidence of stroke (9.1% vs 0% vs 4.0% vs 9.1%, respectively), spinal cord injury (13.6% vs 4.7% vs 8.0% vs 0%, respectively), and in-hospital mortality (9.1% vs 2.3% vs 0% vs 9.1%, respectively). During follow-up, the 10-year overall survival and 7-year aortic event-free rates for TAAAR, DTAR, TARET, and TEVAR were 61.8%, 71.6%, 21.5%, and 26.5% and 93.8%, 84.3%, 74.4%, and 51.4%, respectively. TAAAR had significantly higher overall survival (P = .05) and aortic event-free rates (P = .03) than TEVAR. TARET (hazard ratio, 2.27; P < .01) and TEVAR (hazard ratio, 3.40; P < .01) were independently associated with the incidence of aortic events during follow-up. Conclusions: Considering the optimal primary surgical repair based on long-term outcomes, TEVAR was not a durable treatment option. Patient-specific TAAAR or DTAR should be considered rather than defaulting to minimally invasive primary repairs for all patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm.

Treatment Strategies for Acute Aortic Dissection With Malperfusion: A Retrospective Study.

BACKGROUND: Aortic dissection with malperfusion necessitates emergency surgery and is associated with poor outcomes. Therefore, in this study, we analyzed patients' treatment courses from the initial management to hospital discharge in cases of acute aortic dissection (AAD) with malperfusion and investigated the risk factors associated with mortality. METHODS: We evaluated cases of AAD with malperfusion treated at our institution over a 16-year period from 2007 to 2022. The primary endpoint was in-hospital mortality. The study's primary outcome measure was mortality during hospitalization. We collected and analyzed data encompassing preoperative patient characteristics, Stanford classification, sites of preoperative malperfusion, surgical techniques employed, and postoperative complications. These variables were examined to identify factors associated with in-hospital mortality. RESULTS: During the study period, 366 patients were admitted with AAD, 102 of whom had malperfusion. There were 62 men (61%) and 40 women (39%), with a mean age of 64 ± 13 years (range: 28-87 years). According to the Stanford classification, 75 (74%) and 27 (26%) patients had type A and B aortic dissection, respectively, and 29 patients (28%) presented with shock. Preoperative malperfusion sites included the brain, coronary arteries, abdominal viscera, limbs, and spinal cord in 40 (39%), 10 (10%), 34 (33%), 52 (51%), and six (6%) patients, respectively. Eleven (11%) patients required immediate intervention in the emergency department. The treatments administered to the patients were as follows: ascending aortic replacement, 30 (29%) patients; aortic arch replacement, 34 (33%) patients; root replacement, three (3%) patients; thoracic endovascular aortic repair (TEVAR), 12 (12%) patients; non-anatomic bypass, five (5%) patients; and conservative management, five (5%) patients. In-hospital mortality occurred in 23 (23%) patients. Multivariate logistic regression analysis identified preoperative coronary malperfusion as an independent risk factor of mortality. CONCLUSION: Preoperative coronary malperfusion is an independent risk factor for in-hospital mortality in patients with AAD presenting with malperfusion.

Effects of temperature on transient neurologic dysfunction after total arch replacement.

OBJECTIVES: The relationship between cooling status during aortic surgery with hypothermic circulatory arrest and postoperative neurologic dysfunction remains unknown. In the present study, we evaluated the effect of cooling status on transient neurologic dysfunction after total arch replacement. METHODS: We studied patients who underwent elective total arch replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion from December 2011 to January 2021. Changes in tympanic temperature trends recorded during surgery were plotted. Several parameters, including the nadir temperature, cooling speed, and degree of cooling (cooling area, or the area under the curve of inverted temperature trends from cooling to rewarming as calculated by the integral method), were analyzed. The relationships between these variables and transient neurologic dysfunction were evaluated. RESULTS: Transient neurologic dysfunction was observed in 33 (14.5%) of the 228 included patients. In the transient neurologic dysfunction group, the cooling area was larger (2417.3 vs. 1920.8 °C min; P < 0.001) and the cooling speed was higher (0.68 vs. 0.51 °C/min; P < 0.001) than in the non-transient neurologic dysfunction group. A multivariate logistic model revealed that both the cooling area (odds ratio = 1.13 per 100 °C min; P < 0.001) and cooling speed (odds ratio = 3.69 per °C/min; P = 0.041) were independent risk factors for transient neurologic dysfunction. CONCLUSIONS: Both the cooling area, which indicates the degree of cooling, and cooling speed had significant relationships with transient neurologic dysfunction after total arch replacement. Together, these findings indicate that overcooling and rapid cooling may contribute to brain injury.

Transprosthetic cuff leakage of a bovine pericardial aortic bioprosthesis in a redo case.

A 79-year-old man underwent bioprosthetic valve replacement for aortic regurgitation 10 years previously (Carpentier-Edwards PERIMOUNT Magna Ease, 21 mm; Edwards Lifesciences, Irvine, CA, USA). The indexed effective orifice area decreased to 0.422 cm2/m2, and heart failure symptoms appeared. The patient underwent aortic valve replacement through a redo median sternotomy. A perivalvular leak was observed on transesophageal echocardiography at the time of weaning from cardiopulmonary bypass. The patient was judged to have a leak characteristic of bioprosthetic valves and was monitored closely. Postoperative echocardiography showed that the perivalvular leak had decreased to a trivial level, indicating that the intraoperative decision had been correct. We report this case because such intraoperative judgments are difficult to make.

Intraoperative evaluation for endoleaks using the SCORPION procedure during endovascular aortic repair.

OBJECTIVES: Endoleaks are important complications of endovascular aortic repair. Usually, endoleaks are judged indirectly by aortography or postoperative computed tomography. However, findings from these modalities are difficult to distinguish because of the divergency of endoleaks. Few studies have reported direct visualization of endoleaks. Herein, we introduce a direct procedure for intraoperatively evaluating endoleaks using angioscopy. METHODS: From April 2023, consecutive patients with an abdominal aortic aneurysm, except emergency cases and those of narrow access, seen at Sunagawa City Medical Center were enrolled in our study. Endoleaks were detected by intraoperative angioscopy using a novel endovascular procedure. RESULTS: Seven patients underwent endovascular aortic repair of an abdominal aortic aneurysm with intraoperative angioscopy. None of the enrolled patients experienced complications. The procedure revealed types 2, 3a, and 4 endoleaks. CONCLUSIONS: This is the first study to demonstrate intraoperative visualization of endoleaks using angioscopy. Direct findings observed by this novel procedure might provide information on the velocity and volume of the endoleak, providing comprehensive insights into the intra-sac hemodynamics after the endovascular aortic repair.

A Suspected Case of Adhesion to the Iliac Vein During the Left Femoral Arthroplasty.

An 85-year-old man underwent hemiarthroplasty for a left intertrochanteric femoral fracture at another hospital two years prior. While under outpatient monitoring, the left femur displacement occurred. Therefore, total hip arthroplasty of the left hip was scheduled. However, during acetabular cup insertion damage to the inner plate led to a sudden decrease in blood pressure from 120 to 60 mmHg. The physicians suspected a pelvic vascular injury and promptly stopped the procedure. In case of adhesion between the acetabular cup and the left iliac vein, intraoperative vascular damage would be repaired via endovascular intervention. Subsequently, orthopedic surgery was cautiously performed, taking into account the potential of a vascular injury. The surgery proceeded as planned without vascular intervention. This case involved a patient with suspected injury to the iliac vein and artery during acetabular cup placement. Following comprehensive enhanced CT and angiography tests, orthopedic surgery was performed in preparation for potential vascular damage, demonstrating the multidisciplinary approach to managing such cases.

A Case of Cerebral Arteriovenous Malformation and Malformation of the Lower Limbs.

The case involves a 37-year-old female who was diagnosed with undifferentiated immunodeficiency and protein-losing gastroenteropathy at the age of 26 and was under outpatient care in the gastroenterology department while taking Prednisolone 15mg. At the age of 37, she experienced loss of consciousness and was diagnosed with a right occipital lobe arteriovenous malformation upon investigation. Although initially managed conservatively, she presented the following month with a right-sided headache and vomiting and was urgently transported to our hospital. Imaging with contrast-enhanced CT revealed bleeding from the arteriovenous malformation. Emergency craniotomy was performed, followed by ventricular drainage. Two weeks later, she underwent transcatheter arterial embolization of the main feeder via the right femoral artery approach, followed by excision of the arteriovenous malformation the next day. Subsequently, she had an uneventful recovery. A confirmation CT angiography before discharge revealed severe stenosis of the right common femoral artery, leading to a referral to the cardiovascular surgery department. The stenosis was attributed to the Pro-Glide used for hemostasis during the embolization procedure. Repair surgery was performed, during which CT angiography revealed arteriovenous malformations in both the popliteal fossae and the foot.

A screw-type pacemaker lead implanted in the right atrium perforated the ascending aorta.

BACKGROUND: Perforation by pacemaker leads, although rare, is a complication reported since the introduction of pacemaker therapy. Although historically reported frequencies were as high as 5%, recent reports have cited frequencies ranging from 1 to 2%. We report a case where a screw-type atrial lead slightly penetrated the right atrial wall, causing chronic abrasion of the ascending aorta, resulting in shock. CASE PRESENTATION: A 54-year-old male presented with dilated cardiomyopathy diagnosed at 40 years of age when he developed decompensated heart failure. Despite ongoing treatment, his heart failure worsened, leading to hospitalization at the age of 54. During his hospital stay, he experienced cardiac arrest that required cardiopulmonary resuscitation, followed by a return of spontaneous circulation. He was subsequently transferred to our institution after initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). Echocardiography revealed an ejection fraction of 25%, left ventricular end-diastolic diameter of 60 mm, and severe mitral regurgitation (MR). Transcatheter mitral valve repair was performed to treat severe MR, followed by implantation of a cardiac resynchronization therapy defibrillator (CRT-D). Three months later, the patient was brought to our emergency department by ambulance because of hypotension. Contrast-enhanced computed tomography revealed pericardial effusion causing cardiac tamponade, necessitating emergency pericardial decompression via left fourth intercostal mini-thoracotomy and drain placement. Upon transfer to the intensive care unit, 1200 mL of blood was drained from the chest tube, prompting a return to the operating room for a median sternotomy. It was discovered that the pacemaker lead on the left side of the right atrium had slowly eroded into the aorta, leading to perforation. The ascending aorta was repaired and hemostasis was achieved; the patient recovered uneventfully and was discharged on postoperative day 18. CONCLUSIONS: The pacemaker lead perforated the right atrium; chronic abrasion of the lead against the ascending aorta resulted in bleeding from the ascending aorta 3 months later.

Identification of a Dissection Site in the Internal Thoracic Artery Using Fluorescence Imaging: A Case Report.

A 66-year-old man with a history of type 2 diabetes mellitus who was undergoing hemodialysis presented with angina. Coronary angiography revealed triple-vessel coronary artery disease. He underwent multiple percutaneous coronary interventions due to recurrent restenosis and was referred for coronary artery bypass grafting (CABG). The left internal thoracic artery and bilateral saphenous veins were harvested under general anesthesia. Four CABGs were performed: left internal thoracic artery to the left anterior descending artery; saphenous vein graft to the obtuse marginal branch of the circumflex artery; and saphenous vein graft to two sites in the right coronary artery. Intraoperative assessment with transit-time flow measurements showed no abnormalities, and the surgery was completed. On postoperative day seven, coronary and graft angiography revealed dissection of the left internal thoracic artery at its midportion with restricted flow. On postoperative day eight, a surgical intervention was performed to excise the dissected segment of the left internal thoracic artery. The dissection site was identified by fluorescence imaging. The dissected segment was excised, and the artery was re-anastomosed. The postoperative course was uneventful, and graft angiography performed on postoperative day 22 confirmed good blood flow. Fluorescence imaging was valuable in identifying the dissection site in the left internal thoracic artery.

Huge, Infected Pancreatic Necrosis After Total Arch Replacement in a Patient With Immunoglobulin G4-Related Syndrome.

A 77-year-old male patient with immunoglobulin (Ig)G4-related disease was diagnosed with a 60-mm aortic arch aneurysm and atherosclerosis of the aorta advanced throughout the body. Aortic arch replacement surgery was performed with circulatory arrest at 28°C. One week later, the patient developed acute pancreatitis, followed by encapsulated necrosis in the chronic phase. After debridement surgery, the patient's condition improved.

Early Clinical Results From the Japanese Prospective Multicenter Study to Evaluate Zenith Alpha Abdominal Stent Graft for Abdominal Aortic Aneurysm (JUSTICE) Registry Demonstrate Acceptable Limb Patency at 12 Months.

PURPOSE: Recent reports of the Zenith Alpha abdominal endovascular graft (Zenith Alpha AAA, Cook, Inc., Bloomington, Indiana) have demonstrated an unexpectedly high incidence of limb graft occlusion (LGO). The purpose of this study was to prospectively evaluate the performance of the Zenith AAA in Japan, with a specific focus on LGO. MATERIALS AND METHODS: All endovascular aneurysm repairs (EVARs) for abdominal aortic aneurysms performed using the Zenith Alpha AAA from July 2020 to October 2021 in 23 Japanese hospitals were prospectively evaluated. All computed tomographic images were analyzed in the core laboratory. Late complications were defined as any aneurysm-related events occurring >30 days after EVAR, including aneurysm sac enlargement of >5 mm and any reinterventions performed. Endoleaks without sac enlargement or reintervention were excluded as late complications. RESULTS: During the study period, 147 EVARs were performed using the Zenith Alpha AAA. The mean patient age was 76.5±7.7 years, 84.4% of patients were male, and the mean aneurysm diameter was 52.4±9.2 mm. Instruction-for-use violations were observed in 76 patients (51.7%), primarily associated with a severely angulated proximal neck (>60°). There were six intraoperative complications and 62 additional intraoperative treatments reported, most of which involved preemptive coil embolization of the inferior mesenteric artery (37 cases). Technical success, defined as the absence of type 1 or 3 endoleaks on final angiography, was achieved in 99.3% of patients. At 12 months, there was only one case of type 1/3 endoleak (0.8%) and one aneurysm sac enlargement exceeding 5 mm (0.8%); however, a high incidence of type 2 endoleaks was observed in 35.2% of patients, and aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients. Nine late complications were observed, and the rate of freedom from late complications at 12 months was 93.5%, encompassing four LGOs and one limb graft stenosis (3.4%). CONCLUSIONS: In contrast to recent reports, our Japanese multicenter prospective study demonstrated satisfactory early clinical results, including an acceptable LGO rate, for the low-profile Zenith Alpha AAA. Long-term follow-ups will be performed to confirm the persistence of these outcomes. CLINICAL IMPACT: This study prospectively evaluated the performance of 147 Zenith Alpha AAAs used for endovascular aneurysm repair with core-lab adjudication focusing especially on limb graft occlusion (LGO). At 12 months, aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients, and there was only one type 1/3 endoleak, one aneurysm sac enlargement (>5 mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg." 5mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg.

Mid-term outcomes of physician-modified endograft therapy for complex aortic aneurysms.

OBJECTIVES: Our goal was to evaluate early and mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms from 10 Japanese aortic centres. METHODS: From January 2012 to March 2022, a total of 121 consecutive adult patients who underwent physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were enrolled. We analysed early and mid-term postoperative outcomes, including postoperative complications and mortality. RESULTS: The pararenal and thoraco-abdominal aortic aneurysm groups included 62 (51.2%) and 59 (48.8%) patients, respectively. The overall in-hospital mortality rate was 5.8% (n = 7), with mortality rates of 3.2% (n = 2) and 8.5% (n = 5) in pararenal and thoraco-abdominal aortic aneurysm groups, respectively (P = 0.225). Type IIIc endoleaks occurred postoperatively in 18 patients (14.9%), with a significantly higher incidence (P = 0.033) in the thoraco-abdominal aortic aneurysm group (22.0%, n = 13) than in the other group (8.1%, n = 5). Major adverse events occurred in 7 (11.3%) and 14 (23.7%) patients in pararenal and thoraco-abdominal aortic aneurysm groups (P = 0.074), respectively. The mean follow-up period was 24.2 months. At the 3-year mark, both groups differed significantly in freedom from all-cause mortality (83.3% and 54.1%, P = 0.004), target aneurysm-related mortality (96.8% and 82.7%, P = 0.013) and any reintervention (89.3% and 65.6%, P = 0.002). Univariate and multivariate regression analyses demonstrated that ruptures, thoraco-abdominal aortic aneurysms and postoperative type IIIc endoleaks were associated with an increased risk of all-cause mortality. CONCLUSIONS: The mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were clinically acceptable and comparable with those in other recently published studies. Notably, pararenal and thoraco-abdominal aortic aneurysms represent distinct pathological entities with different postoperative outcomes.

Mitral valve repair for infective endocarditis after esophageal reconstruction: a case report.

BACKGROUND: In patients with retrosternal neo-esophageal conduit after right thoracotomy, the approach to cardiac surgery could be challenging. Particularly, in patients with infective endocarditis, there is a risk of injury to the conduit through standard median sternotomy. Moreover, right lung adhesions could be predicted. Herein, we present a case of successful mitral valve repair in a patient with infective endocarditis through a redo right thoracotomy after esophageal reconstruction. CASE PRESENTATION: A 66-year-old male patient was diagnosed with infective endocarditis and a large anterior mitral leaflet vegetation after a previous esophageal reconstruction via right thoracotomy for esophageal cancer. Due to the retrosternal esophageal reconstruction, we performed a mitral valve repair through a redo right thoracotomy. After resecting the vegetation, the defect was closed with a fresh autologous pericardial patch. Mitral valve annuloplasty was performed. Postoperatively, antibiotics controlled the infection. The patient was discharged on postoperative day 30. CONCLUSIONS: Successful mitral valve repair was performed for infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

Physician-modified inner-branched endovascular repair with re-intervention.

OBJECTIVES: Treatment of thoracoabdominal aortic aneurysms in high surgical risk patients can be challenging. Reports of physician-modified inner-branched endovascular repair (PMiBEVAR) are increasing. Despite low morbidity and mortality rates, re-interventions for endoleaks with these grafts are serious. There are no reports of additional treatment for PMiBEVAR failure. METHODS/RESULTS: A 75-year-old man presented to our hospital with a Crawford's type IV thoracoabdominal aortic aneurysm. A PMiBEVAR was performed. Postoperative computed tomographic angiography revealed an endoleak from the inner branch of the right renal artery. A re-intervention was performed with coil embolization of the endoleak. Imaging after re-intervention showed successful obliteration of the endoleak. CONCLUSIONS: We thereby report a successful case of re-intervention for PMiBEVAR failure.

One-Year Clinical Outcomes and Prognostic Factors Following Revascularization in Patients With Acute Limb Ischemia　- Results From the RESCUE ALI Study.

BACKGROUND: Acute limb ischemia (ALI) is a limb- and life-threatening condition and urgent treatment including revascularization should be offered to patients unless the limb is irreversibly ischemic. The aim of this study was to investigate 1-year clinical outcomes and prognostic factors following revascularization in patients with ALI.Methods and Results: A retrospective, multicenter, nonrandomized study examined 185 consecutive patients with ALI treated by surgical revascularization (SR), endovascular revascularization (ER), or hybrid revascularization (HR) in 6 Japanese medical centers from January 2015 to August 2021. The 1-year amputation-free survival (AFS) rate was estimated to be 69.2% (95% confidence interval [CI], 62.8-76.2%). There were no significant differences among SR, ER, and HR regarding both technical success and perioperative complications. Multivariate analysis revealed that Rutherford category IIb and III ischemia (hazard ratio [HR]: 1.86; 95% CI: 1.06-3.25), supra- to infrapopliteal lesion (HR: 2.06; 95% CI: 1.08-3.95), and technical failure (HR: 2.58; 95% CI: 1.49-4.46) were independent risk factors for 1-year AFS. CONCLUSIONS: Rutherford category IIb and III ischemia, supra- to infrapopliteal lesions, and technical failures were identified as independent risk factors for 1-year AFS. Furthermore, patients with multiple risk factors had a lower AFS rate.

Multivariate analysis of the factors affecting medical students' decision to join the cardiovascular surgery department.

OBJECTIVE: The purpose of this study was to statistically analyze the factors that influence cardiovascular surgery recruitment. METHODS: Fifth- and sixth-year medical students and first-year residents who participated in cardiovascular surgery-related events at our university over a 10-year period from April 2013 to August 2022 were included. The primary endpoint was admission to the department of cardiovascular surgery. Gender, participation in sixth-year elective clinical training, participation in national academic conferences, participation in cardiovascular surgery summer school, and the cost of participation in these events (airfares and lodging) were included as analytic factors. RESULTS: Fifty-three participants attended cardiovascular surgery events during the study period. The sample included 48 males (84%) and 9 females (16%), and 3 fifth-year medical students (5%), 45 sixth-year students (79%), and 9 students in their first year of clinical training (16%). Eighteen (32%) of the participants eventually joined the department. Gender, participation in national academic conferences, cardiovascular surgery summer school, and cost of participation were not significantly related to the decision to join the department, but participation in elective clinical training was significantly positively related to the decision to join the department for sixth-year students (p < 0.01). CONCLUSIONS: We statistically analyzed the factors involved in the recruitment of students and initial clinical residents to the department of cardiovascular surgery. The results showed that participation in elective clinical training was significantly positively associated with the decision to join the department, suggesting that efforts to encourage participation in elective clinical training are important.

Mitral Valve Infective Endocarditis Associated With Prednisolone-Induced Immunosuppression: A Case Report.

A 74-year-old man with pemphigoid, for which he was on a daily regimen of 14 mg of prednisolone and immunosuppressive drugs, was admitted to the orthopedic surgery department with a fever of 38 °C. An MRI scan of his head revealed multiple bilateral cerebral infarcts, and echocardiography showed a 30-mm structure attached to the anterior apex of the mitral valve. The patient was diagnosed with infective endocarditis and administered antibiotic therapy. Five days after the diagnosis, the patient underwent mitral valve surgery, during which the mitral valve was observed to be severely deteriorated and hence replaced with a bioprosthetic valve. Blood flow disturbance was observed in the right lower extremity, and a thrombectomy was performed. A dispersed vegetation around the heart was observed and removed. After the surgery, the patient progressed without mediastinitis and had a good postoperative course. He was discharged from the hospital on the 56th postoperative day after continued antibiotic therapy.