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Percutaneous drainage and staged valve replacement followed by laparoscopic splenectomy in infective endocarditis with splenic abscess

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Abstract

Splenic abscess is a severe complication of infective endocarditis. The need for splenectomy to control prosthetic valve infection remains controversial. Here, we present the case of a 49-year-old man who complained of fever and general fatigue. Blood cultures grew Group G Streptococcus, and intravenous antibiotics were started. Abdominal computed tomography showed splenic abscess; thus, percutaneous drainage was performed. Two-dimensional transthoracic echocardiogram revealed a mobile vegetation on the right coronary cusp of the aortic valve with mild aortic regurgitation. The patient underwent aortic valve replacement using a 23-mm SJM Regent mechanic valve, followed by laparoscopic splenectomy 3 days later. The patient was asymptomatic without recurrence of infection 13 months postoperatively. Current guidelines recommend that splenectomy should be performed first, followed by valve replacement. However, we performed valve surgery first because of the risk of embolism. Depending on the patient’s condition, performing splenic drainage and valve replacement first may be considered.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Rinku General Medical Center, Rinku Oraikita 2-23 izumisano, Osaka, 072-469-3111, Japan

    Fumiyoshi Saijo, Toshihiro Funatsu, Junya Yokoyama & Masaaki Ryomoto

  2. Department of Diabetology, Nagayama Hospital, Okubo Higashi 1-1-10 Kumatori Sennnann, Osaka, 072-453-1122, Japan

    Kosuke Hayashi

Authors
  1. Fumiyoshi Saijo
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  2. Toshihiro Funatsu
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  3. Junya Yokoyama
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  4. Masaaki Ryomoto
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  5. Kosuke Hayashi
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Correspondence to Fumiyoshi Saijo.

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Saijo, F., Funatsu, T., Yokoyama, J. et al. Percutaneous drainage and staged valve replacement followed by laparoscopic splenectomy in infective endocarditis with splenic abscess. Gen Thorac Cardiovasc Surg 70, 285–288 (2022). https://doi.org/10.1007/s11748-021-01741-y

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  • DOI: https://doi.org/10.1007/s11748-021-01741-y

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