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Case reports

Mitral valve surgery with surgical embolectomy for mitral valve endocarditis complicated by septic coronary embolism

^a Department of Thoracic and Cardiovascular Surgery, Guro Hospital, College of Medicine, Korea University, 80 Guro-dong, Guro-ku, Seoul 152-703, Republic of Korea
^b Division of Cardiology, Sejong Heart Institute, Bucheon, Republic of Korea
^c Division of Cardiovascular Surgery, Sejong Heart Institute, Bucheon, Republic of Korea

Received 3 September 2007; received in revised form 21 September 2007; accepted 25 September 2007.

^_* Corresponding author. Tel.: +82 2 2626 3104; fax: +82 2 2626 6377. (Email: mdmjbaek{at}korea.ac.kr).

Acute myocardial infarction (AMI) complicated by septic coronary embolism due to active infective endocarditis is rare but usually fatal. We report a case of successful mitral valve surgery with surgical embolectomy in a 27-year-old man with an AMI complicated by septic coronary embolism due to mitral valve endocarditis. A chest radiograph revealed cardiomegaly and marked pulmonary edema. A transthoracic echocardiogram disclosed severe mitral regurgitation with highly mobile vegetations and hypokinesia of the left ventricular apex. The electrocardiographic findings of ST segment elevation in leads V2-4 and elevated cardiac enzyme levels were strongly suggestive of an acute anterolateral AMI. Nevertheless, emergent cardiac surgery was needed without selective coronary angiography because of intractable heart failure and life-threatening ventricular tachyarrhythmia requiring cardiopulmonary resuscitation. A total occlusion of the distal left anterior descending artery caused by embolic vegetation and thrombus, which was incidentally detected intraoperatively, was successfully recanalized by surgical embolectomy and thrombectomy using a direct coronary incision. The mitral valve endocarditis was managed with wide debridement and mechanical valve replacement. Three years after the surgery a follow-up echocardiogram showed no abnormalities of the regional wall, motion in the left ventricle and the patient is living an active life without any complications.

Key Words: Coronary embolism • Embolectomy • Acute myocardial infarction • Endocarditis