naa a22 4500 510728294 CHVBK 20180411082943.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s11748-013-0241-5 doi (NATIONALLICENCE)springer-10.1007/s11748-013-0241-5 Current treatment of active infective endocarditis with brain complications [Elektronische Daten] [Takashi Miura, Kiyoyuki Eishi] We describe the optimal timing of surgery in active infective endocarditis patients with brain complications. (1) Non-hemorrhagic infarction: elective surgery has been recommended in patients with non-hemorrhagic infarction. However, the timing is changing to an earlier phase. Recent studies have shown that silent brain embolism and small-size infarction (15-20mm) without coma can be operated safely without delay. On the other hand, in patients with large non-hemorrhagic infarction with impaired consciousness, early surgery is not recommended. (2) Non-ruptured infectious intracranial aneurysm: treatment strategies for patients with infectious aneurysms without rupture remain controversial. However, the treatments are generally as follows. If the intracranial aneurysm without rupture decreases in size by administration of effective antibiotics, neurosurgery will not be required and cardiac surgery can be prioritized without delay. When the aneurysm without rupture enlarges and changes its morphology, neurosurgery or endovascular surgery should be prioritized to prevent its rupture. (3) Hemorrhagic stroke: this type is classified into primary intra-cerebral hemorrhage due to simple necrotic arteritis, hemorrhagic transformation of ischemic infarcts, and rupture of intracranial infectious aneurysms. Among these, primary intracerebral hemorrhage is the most frequently observed. In patients with the primary intracerebral hemorrhage, surgery must be postponed for at least 4weeks to prevent exacerbation of bleeding. In patients with ruptured infectious aneurysm, neurosurgery or endovascular surgery is performed initially and cardiac surgery should be postponed at least 2-3weeks. The Japanese Association for Thoracic Surgery, 2013 Active infective endocarditis nationallicence Brain complications nationallicence Timing of surgery nationallicence Non-hemorrhagic infarction nationallicence Hemorrhagic stroke nationallicence Infectious intracranial aneurysm nationallicence Miura Takashi Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, 852-8501, Nagasaki, Japan aut Eishi Kiyoyuki Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, 852-8501, Nagasaki, Japan aut General Thoracic and Cardiovascular Surgery Springer Japan 61/10(2013-10-01), 551-559 1863-6705 61:10<551 2013 61 11748 https://doi.org/10.1007/s11748-013-0241-5 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11748-013-0241-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Miura Takashi Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, 852-8501, Nagasaki, Japan aut NATIONALLICENCE 700 1- Eishi Kiyoyuki Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, 852-8501, Nagasaki, Japan aut NATIONALLICENCE 773 0- General Thoracic and Cardiovascular Surgery Springer Japan 61/10(2013-10-01), 551-559 1863-6705 61:10<551 2013 61 11748 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer