Anesthetic and hemodynamic management of a rare case of Brucella multivalvular endocarditis in cardiogenic shock undergoing emergency aortic valve replacement and mitral valve repair

Abstract

We describe a very rare case of human brucella multivalvular endocarditis. Patient presented in a state of cardiogenic shock with low urine output and a history of breathlessness. Patient was diagnosed to have brucellosis 2 months back by blood cultures and agglutination tests and was receiving doxycycline and rifampicin therapy. Echocardiography showed severe aortic regurgitation, moderate mitral regurgitation, severe left ventricular dysfunction and a mobile vegetation attached to the aortic valve. Patient was scheduled for emergency surgery; while preparing for surgery hemodynamic monitoring, non-invasive ventilation and inotropic supports were started. During surgery, the aortic valve was found perforated and the aortomitral continuity was disrupted. Aortic valve replacement and mitral valve repair were performed. Hemofiltration was used during cardiopulmonary bypass. Weaning from bypass was achieved with the help of inodilators, dual chamber pacing and intra-aortic balloon pump.

Brucella prosthetic valve endocarditis with septic and cardiogenic shock

“…Brucella endocarditis with cardiogenic shock is not well described in literature. Kandasamy et al reported one case of severe left ventricular dysfunction with severe aortic regurgitation and hemodynamic instability, in which patient survived after surgical and medical therapy [ 7 ]. Brucella endocarditis presenting with unusual case of septic shock after 50 years of quiescence was described by Haran et al in her case report [ 8 ].…”