[Re-operation Using Bovine Pericardium for Infective Endocarditis after Aortic Valve Neocuspidization;Report of a Case].

A 70-year-old man, who had undergone aortic valve neocuspidization using his own pericardium 8 months before, complained of back pain, and was diagnosed with pyrogenic spondylitis. As the result of blood culture, Enterococcus faecalis was found to be the causative bacterium, and antibiotic therapy was started. Six days after admission, hemodynamics collapsed suddenly, and percutaneous cardio-pulmonary support was established. Echocardiography showed severe aortic valve regurgitation, and he was diagnosed with active infective endocarditis. We performed re-do aortic valve neocuspidization using bovine pericardium. There was a tear on the non-coronary cusp and the cusps were thickened because of infection. Aortic annular tissue was not destroyed and we could fix the neo-valve directly to the annulus. After these procedures, severe reduction of antero-septal wall motion was noted, which suggested dissection of the main trunk of the left coronary artery. Coronary artery bypass grafting to the left anterior descending and the circumflex branches was added. The patient came off percutaneous cardio-pulmonary support 5 days after surgery. Although trivial aortic regurgitation remained, he was discharged after 2 months of rehabilitation.