Simultaneous Enterococcus Faecalis Mitral Valve Endocarditis, Mycotic Aortoiliac, and Intracranial Aneurysms: A Surgical Dilemma.

Mycotic aortic aneurysms comprise <5% of all aortic aneurysms, but have a high risk of rupture if not treated urgently. Concomitant valvular infective endocarditis poses additional therapeutic challenges in relation to staged repair. Current surgical recommendations for mycotic aortic aneurysms involve urgent repair, due to the high risk of rupture and associated mortality. The presence of infective endocarditis necessitates early valve replacement to avoid further systemic emboli or seeding of vascular grafts; however, the risk of heparin loading during cardiopulmonary bypass on a friable aorta poses significant risks. Staged repair with an initial, temporary exclusion graft can reduce these risks but is poorly studied in the literature. This study reported a case of a 60-year-old male patient who presented with Enterococcus faecalis native mitral valve infective endocarditis with associated mycotic aortoiliac aneurysms and who successfully underwent staged repair.