Chiharu Nakamura

Spontaneous splenic rupture after mitral valve replacement for infective endocarditis

We report a successful treatment of massive bleeding due to spontaneous splenic rupture after mitral valve replacement. A 61-year-old man was admitted to our hospital for intermittent high fever. An echocardiogram demonstrated a large vegetation on the posterior cusp of the mitral valve and mitral regurgitation of moderate degree. Staphylococcus epidermidis was cultured from his arterial blood. He underwent a mitral valve replacement after 3 weeks of antimicrobiological therapy with penicillin G crystalline and minocycline hydrochloeide. The patient fell into hemorrhagic shock on postoperative day 11 after complaining dull pain on his left upper abdomen for 3 days. A computed tomography demonstrated a splenic rupture and massive hematoma in the retroperitoneum. A splenic arterial embolization was done before splenectomy. The blood and clot of 2800 g were sucked from peritoneal and retroperitoneal cavities. There were no mycotic aneurysms nor abscess but the torn capsule on the swelled and partially necrotic spleen. The patient discharged uneventfully on postoperative day 43. Infective endocarditis frequently causes splenic infarction but rarely splenic rupture. Anticoagulation therapy after mitral valve replacement might have emphasized the bleeding in the patient.

Spontaneous rupture of the descending aorta through atherosclerotic plaque: Report of a case

Spontaneous rupture of the thoracic descending aorta is rare, and uniformly fatal without surgery. We report herein the case of a man in whom such a rupture was successfully treated with emergency surgery. We believe that the rupture in this patient was most likely associated with perforation through an atherosclerotic plaque of the descending aorta and was induced by sudden hypertension.

Clinical Status of the Late Stage after Valvulectomy without Prosthetic Replacement.

活動期感染性心内膜炎に対し, 右心系の弁切除非置換術を施行した3例の術後遠隔期を報告した. 肺動脈弁全切除を施行した1例と三尖弁部分切除を施行した1例では安定した状態にあったが, 三尖弁全切除を施行した1例では, 進行性の右心系の拡大を認めた. 三尖弁位の逆流による右心の容量負荷の増大によるものと思われた. 右心系の弁置換術の遠隔の遠隔成績に問題が残る現在, 三尖弁では可及的に遺残組織による弁形成術か, パッチによる弁再建術を行うことが望ましいと考えられた.