Successful mitral valve replacement for infective endocarditis in a patient with liver cirrhosis and acute renal failure

Abstract

Patients with liver cirrhosis and acute renal failure are considered high risk for open cardiac surgery under cardiopulmonary bypass. A 58-year-old female patient with severe mitral regurgitation due to bacterial endocarditis associated with moderate liver cirrhosis was admitted to our clinic for the treatment of acute pulmonary edema. Preoperative hepatic function state was estimated as Child- Pugh class B. Intravenous gentamicin and vancomycin were initiated for the treatment of acute infective endocarditis. During antimicrobial therapy, the patient developed druginduced acute renal failure. We immediately performed mitral valve replacement under cardiopulmonary bypass due to progressive heart failure. The postoperative course was problem-free and the patient was discharged. With careful preoperative preparation and good perioperative management, open heart surgery can be performed with a positive outcome in acute infective endocarditis patients with moderate liver cirrhosis and acute renal failure.