Impact of Early Surgical Treatment on Postoperative Neurologic Outcome for Active Infective Endocarditis Complicated by Cerebral Infarction Daisuke Yoshioka,

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Impact of Early Surgical Treatment on Postoperative Neurologic Outcome for Active Infective Endocarditis Complicated by Cerebral Infarction Daisuke Yoshioka, MD, Taichi Sakaguchi, MD, PhD, Takashi Yamauchi, MD, PhD, Shuhei Okazaki, MD, PhD, Shigeru Miyagawa, MD, PhD, Hiroyuki Nishi, MD, Yasushi Yoshikawa, MD, Satsuki Fukushima, MD, PhD, Shunsuke Saito, MD, Yoshiki Sawa, MD, PhD The Annals of Thoracic Surgery Volume 94, Issue 2, Pages 489-496 (August 2012) DOI: 10.1016/j.athoracsur.2012.04.027 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Acute cerebral infarction was defined as high-density area (A: arrow) with diffusion-weighted magnetic resonance imaging (DW-MRI), whereas chronic infarction represents low-density area (B: arrowhead). (A) The patient was diagnosed with infective endocarditis complicated with acute right cerebellum infarction and underwent operation 2 days after diagnosis. (B) Postoperative DW-MRI showed neither hemorrhagic transformation nor enlargement of area of infarction. The Annals of Thoracic Surgery 2012 94, 489-496DOI: (10.1016/j.athoracsur.2012.04.027) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Relationships between preoperative cerebral infarction (CI) symptoms and prevalence of acute CI. (DW-MRI = diffusion-weighted magnetic resonance imaging.) The Annals of Thoracic Surgery 2012 94, 489-496DOI: (10.1016/j.athoracsur.2012.04.027) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The relationships between the size of respective acute cerebral infarction (CI) and duration between CI diagnosis and operation. Only 1 CI, 58 mm in diameter, showed hemorrhagic transformation postoperatively (•). The other 131 CIs (◯) showed neither hemorrhagic transformation nor enlargement. Two patients with 3 CIs who underwent operations more than 70 days after diagnosis were not shown in the figure. The Annals of Thoracic Surgery 2012 94, 489-496DOI: (10.1016/j.athoracsur.2012.04.027) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions