Rupture of an infectious intracranial aneurysm involving two parent arteries after surgical treatment of infective endocarditis

Abstract

Management of patients with infectious intracranial aneurysms (IIAs) who require valve replacement remains a challenge. Although there is potential risk of aneurysmal rupture associated with cardiac surgery, there have been few reported ruptures of IIAs during the perioperative period of valve replacement. We present a unique patient who suffered intracerebral hemorrhage due to rupture of an IIA 2 weeks after mitral valve replacement. This unique aneurysm is fed by 2 adjacent branches of the left middle cerebral arteries. Direct clipping of the aneurysm was successfully performed using 2 clips with preservation of the parent arteries. This case demonstrates that although it is rare, rupture of an untreated IIA might occur during the perioperative period of cardiac surgery. For patient safety, definitive treatment of unruptured IIAs is recommended before cardiac surgery, especially when long-term anticoagulation is needed after surgery.