A 60-year-old man was admitted to our hospital for investigation of dyspnea and disorientation with right hemiplegia. Echocardiography showed thickened mitral valve leaflets with vegetations and severe mitral regurgitation. Blood cultures grew Staphylococcus aureus. During the operation, perforation and destruction of the mitral valve leaflets and vegetations were confirmed. Debridement of the infected tissues resulted in segmental disruption of the posterior mitral fibrous annulus. Reconstruction of the mitral annulus with porcine pericardium treated with glutaraldehyde and mitral valve replacement were successful. The patient's postoperative course was complicated with metastatic cerebral and splenic abscesses. After splenectomy on the 8th postoperative day, he gradually recovered without major neurologic sequelae. We believe that reconstruction of the mitral valve annulus with pericardium, especially autologous pericardium, is reliable and useful for the treatment of patients with disruption of the mitral valve annulus.
Pulmonary thromboembolism (PTE) occurs in various situations [1,2], and is also well known as a major complication after surgery [1,3]. Compared with the early 2000's, the incidence of peri-surgery PTE fell in the late 2000's, probably due to improved venous thromboembolism (VTE) prophylaxis [1, 3]. Kunisawa et al. have reported that the incidence of PTE associated with surgery was 0.05% (538 out of 1,016,496 patients) and that the PTE cases consisted of 399 females and 199 males [4]. However, it remains unclear which surgeries are associated with more frequent incidence of peri-operative PTE. Therefore, we examined the incidence of peri-operative PTE in various surgical procedures, and the progression of chronic thromboembolic pulmonary hypertension (CTEPH), in which pulmonary arteries are occluded by chronic thrombus [5,6]. This is a multi-center, prospective, observational study, which involved 9 hospitals
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