Ruptured Mycotic Aneurysm and Cerebral Vasospasm in the Setting of Endocarditis and Heart Failure Requiring Cardiothoracic Surgery: Case Report and Literature Review

BACKGROUND: Ruptured mycotic aneurysm in the setting of cardiac failure and cerebral vasospasm presents unique management challenges. CASE DESCRIPTION: A patient with a ruptured mycotic aneurysm with subarachnoid hemorrhage, cerebral vasospasm, and endocarditis with heart failure successfully underwent craniotomy, neuroendovascular treatment, and cardiopulmonary bypass for mitral valve replacement while in cerebral vasospasm. This case highlights clinical management strategies for a patient with a ruptured mycotic aneurysm, subarachnoid hemorrhage, cerebral vasospasm, endocarditis, and heart failure. CONCLUSIONS: Open craniotomy, neuroendovascular treatment, and cardiac surgery strategies can be used when treating patients with ruptured mycotic aneurysms and cardiac failure. When the patient also has cerebral vasospasm, maintenance of mean arterial pressure is paramount.