僧帽弁形成術後に致死的脳出血をきたした活動期感染性心内膜炎の1例

Fatal Cerebral Hemorrhage after Mitral Valve Repair for Active Infective Endocarditis：Report of a Case

はじめに　感染性心内膜炎（IE）には中枢神経系の合併症が少なくない．脳梗塞が多いが，脳出血も5％程度の頻度で起こり，予後は不良である1，2）．脳出血は脳動脈瘤がなくても発症する可能性があり，弁膜症に対する手術後には，抗凝固薬服用による脳出血の重篤化も懸念される．活動期IEに対する僧帽弁形成術後に致死的な脳出血をきたした症例を経験したので，報告する．

Cerebral hemorrhage is a known complication of infective endocarditis （IE） and is associated with a high mortality rate. We herein present a case of fatal cerebral hemorrhage occurring after successful mitral valve repair in a patient in active phase of IE. A 58-year-old male with active IE underwent an urgent mitral valve repair due to systemic embolisms and a massive mobile vegetation on the mitral valve. During the surgery, a rolled autologous pericardium was fixed onto the annulus, therefore we initiated anticoagulation therapy with warfarin. A follow-up brain MRI on the 18th postoperative day showed several cerebral micro bleedings, and on the next day, the patient suffered massive and fatal cerebral hemorrhage. As cerebral hemorrhage can be fatal especially in patients taking anticoagulants, we believe that anticoagulation therapy should be avoided after mitral valve repair in patients who have cerebral micro bleeding in active phase of IE.