急性期多発脳梗塞およびくも膜下出血を合併した活動期大動脈弁感染性心内膜炎の1例

Aortic Valve Replacement for Active Infective Endocarditis with Multiple Cerebral Infarctions and Subarachnoid Hemorrhage：Report of a Case

はじめに　中枢神経合併症を伴った感染性心内膜炎の外科治療は，人工心肺の使用によって梗塞や出血が増悪する可能性がある．われわれは，多発脳梗塞，くも膜下出血（SAH）の急性期に活動期大動脈弁感染性心内膜炎に対して人工弁置換術を行い救命した1例を経験したので報告する．

We report a case of successful surgical treatment of infected aortic valve endocarditis with intractable heart failure, multiple cerebral infarction, and subarachnoid hemorrhage. A 46-year-old man who had fever for two weeks and subsequent left hemiplegia was admitted to our hospital. Brain computed tomography （CT） and magnetic resonance imaging （MRI） revealed multiple cerebral infarction and subarachnoid hemorrhage. Echocardiography showed severe aortic regurgitation with a huge mobile vegetation. Despite medical treatment, chest X-ray revealed progressive pulmonary congestion. We performed aortic valve replacement three days after admission. Cerebral hematoma got slightly larger, but neurological symptom did not worsen. Postoperative course was uneventful. Perioperative antibiotic administration was continued and he was discharged on the postoperative day 46.