A case report of early valve replacement surgery in infective endocarditis with mycotic cerebral aneurysm

Mycotic cerebral aneurysm is a relatively infrequent complication of infective endocarditis. However, rupture and intra-cranial hemorrhage involves so high a mortality that few patients can be saved from this condition. We reported a 22-year-old woman with mitral regurgitation and ruptured mycotic cerebral aneurysm caused by infective endocarditis. Vegetation floating between the left atrium and the ventricle was observed by UCG. It was difficult to decide which operation should be done first, valve replacement or excision of cerebral aneurysm. To avoid further intracerebral bleeding caused by anticoagulant therapy connected with cardiotomy, the cerebral aneurysm was excised prior to the valve replacement. Mitral valve was replaced with a Björk-Shiley prosthetic valve 48 hours after the craniotomy. The postoperative course was uneventful and no neurological deficit was found. This report indicates that valve replacement surgery can be successfully performed only 48 hours after craniotomy without any bleeding complications.