Kyobu geka. The Japanese journal of thoracic surgery
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Review Case Reports
[A case of tricuspid infective endocarditis in a drug addict].
This report describes a successful operative case of tricuspid infective endocarditis in a drug addict. A 24-year-old man with a history of drug addiction (6 months) complained of general fatigue and high fever. Echocardiography showed a large vegetation attached to the tricuspid valve and severe tricuspid regurgitation. ⋯ However, subsequent severe heart failure necessitated emergency operation. The tricuspid valve was replaced with Carpentier-Edwards bioprosthesis because of severe destruction of the tricuspid valve. The postoperative course was uneventful and he has remained free from endocarditis for 15 months after surgery.
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Review Case Reports
[A case of heart operation in infective endocarditis after brain surgery for mycotic cerebral aneurysm].
Complications of infective aneurysm are not rare in patients with infective endocarditis. An optimal timing of heart operation after brain surgery for hemorrhage is controversial. We reported a 19-year-old woman with ventricular septal defect (type II), mitral regurgitation and ruptured cerebral aneurysm with infective endocarditis. ⋯ Conservative therapy was continued for infective endocarditis until heart failure appeared. Heart operation was successfully performed 41 days after brain surgery without cerebral complication. This report indicates that heart operation might be avoided at the early postoperative stage of brain surgery for cerebral aneurysm with hemorrhage.
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Penetrating atherosclerotic aortic ulcers (PAU) can cause aortic dissection. Of 38 autopsy cases with aortic dissection, 6 (15.8%) had severe atherosclerotic changes, resembling those of PAU, at the site of entry (SE). Clinicopathological data on these patients were compared with those on 32 cases with nonatheromatous dissection (5 with Marfan syndrome or its forme fruste and 27 without Marfan syndrome) and 13 with atherosclerotic saccular aneurysms. ⋯ Immunohistochemical examination of the SE revealed that MMP-1, 2, 9 and TIMP-2 were expressed in macrophages and/or interstitium, similar to the findings in atheromatous plaque or PAU. We propose that atherosclerosis-related aortic dissection differs from the usual classical aortic dissection. Patients with this lesion have a high risk of re-dissection from the new SE in the same lesion.