[Valve replacement in infective endocarditis with mycotic aneurysm].

We successfully performed craniotomy and mitral valve replacement on a patient with bacterial endocarditis and ruptured intracranial aneurysm. A 15-year-old woman with fever and heart murmur was admitted to another hospital. Infective endocarditis and mitral valve regurgitation was diagnosed and treated with antibiotics. About one month after admission the patient suddenly showed severe headache and hemiparesis. Brain CT demonstrated intracerebral and subarachnoidal hemorrhage. The patient was unconscious when transferred to Mitsui Memorial Hospital where cerebral angiography showed anterior cerebral aneurysm and echocardiography showed mitral valve vegetation. We judged the necessary mitral valve replacement could be delayed until the aneurysm had been stabilized. We therefore began treatment using a different antibiotic but, in spite of this, 10 days later the aneurysm had enlarged dramatically. As conservative treatment was ineffective, a clipping operation was done to prevent re-rupture at the time of mitral valve replacement which could not be delayed much longer. 10 days later, cerebral 4 vessel study was done which showed no abnormality. Mitral valve replacement was then done and the patient was discharged in good health 64 days after the valve replacement.