Infective Endocarditis Followed by Mycotic Aneurysm of the Ulnar Artery

(Department of Cardiovascular Surgery, Bell Land General Hospital, Osaka, Japan)

Takumi Ishikawa Katsuaki Hige Takanobu Aoyama
We present a surgical case of mycotic aneurysm of the ulnar artery occurring 2 months after surgical treatment for infective endocarditis (IE). A 59-year-old man was referred to our hospital because of dyspnea and fever. An echocardiogram showed severe mitral regurgitation with vegetations. Blood culture disclosed Methicillin-resistant Coagulase Negative Staphylococcus (MRCNS), and brain computed tomography (CT) demonstrated an intracranial hemorrhage in the right posterior lobe. After one month of antibiotic treatment, mitral valve replacement (MVR) was performed successfully. Antibiotic treatment was continued postoperatively for 4 weeks; the C-reactive protein (CRP) level and peripheral white blood cell count were reduced to the normal range. Two months after MVR, a pulsatile mass rapidly increasing in size was seen in his right forearm. Contrast-enhanced CT showed aneurysm formation in his right ulnar artery. The aneurysm was managed by excision, and the brachial artery was reconstructed with a reversed saphenous vein graft. It is essential when observing the course of IE patients to bear in mind at all times that a healed mycotic aneurysm might increase in size.
@Jpn. J. Cardiovasc. Surg. 37: 285-287 (2008)