Complicated brucella endocarditis of the aortic valve

摘要

Endocarditis is a rare and the most fatal complication of brucellosis and can cause severe cardiac injuries.Generally aortic valve invasion is seen.We describe a case of Complicated brucella endocarditis of the aortic valve. Introduction Brucellosis shows various clinical signs and can affect different organs.Although rare,endocarditis is important due to its fatality potential (1). Brucella endocarditis had been first reported in 1906, but surgical approach as a treatment modality has been introduced in 1964(2).Immediate surgery after medical treatment is very important because delaying surgery may lead to that are difficult to repair(3). Case Presentation Our case was a 46-year-old male. He was an employee in animal husbandry. His chief complaints were fatigue and dyspnea for 2 months. After his admission to our institution he was diagnosed as brucella endocarditis and severe aortic regurgitation. Antibiotic regimen with two agents was completed to 6 weeks of duration. Transthoracic echocardiography revealed severe aortic regurgitation with left ventricular hypertrophy (63/44 mm). Moreover, at supravalvular level of the aortic valve, a vegetative mass of 1.5x0.6 cm was detected. Another mobile and calcified vegetative mass of 0.5x0.8 cm was located on the left coronary cusp. Pulmonary arterial pressure was measured as 55 mm Hg and moderate tricuspid regurgitation was identified. The remaining valvular structures were normal. With these findings, we brought our patient into the operating room. We carefully performed median sternotomy and routine cannulation with minimal manipulation.Arrest was achieved with moderate hypothermia of 28?c,and incompressive retrograde isothermic potassiumed blood cardioplegia.Following aortotomy we explored; a normal left coronary cusp. On the other hand; there were vegetation, lysis of the leaflet and commissural destruction with excessive inflammation identified next to the commissure between right and non-coronary cusps (Figures 1 & 2).