2024 Volume 53 Issue 6 Pages 318-323
A 66-year-old man with a history of pyogenic spondylitis a month before was presented with dyspnea. Severe aortic regurgitation due to infective endocarditis was suspected in transthoracic echocardiogram, and emergency surgery was conducted. The aortic valve with three cusps was markedly destroyed with vegetation. After resecting the cusps, there was a cavity just below the commissure between the left and noncoronary cusp (intervalvular fibrous trigon). In retrospective findings of intraoperative pre-cardiopulmonary bypass transesophageal echocardiogram, a left ventricular diverticulum with paroxysmal movement had been detected at the same place. The diverticulum was left untreated to shorten cardiac arrest time because of low left ventricular function, and aortic valve replacement alone was performed. Cardiopulmonary bypass was weaned with intra-aortic balloon pumping (IABP). Percutaneous cardiopulmonary support (PCPS) was initiated owing to hypotension in the intensive care unit. The PCPS and IABP were discontinued on postoperative day (POD) 5 and 6, respectively. Torsades de pointes and ventricular fibrillation occurred respectively 2 h after weaning the PCPS and on POD9, but recuperated to sinus rhythm within a minute. A 6-week course of antibiotic infusion was planned, and the patient is now undertaking rehabilitation on POD30 for discharge.
