[Three Mitral Valve Operations in a Patient with Trousseau Syndrome and Nonbacterial Thrombotic Endocarditis Caused by Ovarian Cancer].

A 52-year-old woman was admitted to our hospital for acute right hemi-paresis, left homonymous hemianopia, and fever. Magnetic resonance imaging of the brain showed multiple cerebral infarctions and transesophageal echocardiography (TEE) revealed a vegetation on the posterior leaflet of her mitral valve. Mitral valve repair was performed under a diagnosis of infective endocarditis (IE). Further multiple cerebral infarctions occurred on the 11th postoperative day, resulting in left hemiplegia and dysarthria. TEE revealed vegetations on her mitral valve and mitral valve replacement (MVR) was performed. Microscopic examination of the resected valve showed mild lymphocytic infiltration, but no bacterial or fungal organisms were detected. On the 66th day after the initial surgery, she developed deep vein thrombosis and acute pulmonary embolism. Abdominal computed tomography showed a huge ovarian tumor, and TEE demonstrated vegetations on the left atrial wall, the aortic valve, and the mechanical valve immobilizing one of the leaflets. The patient was finally diagnosed as having Trousseau syndrome caused by an ovarian tumor and non-bacterial thrombotic endocarditis( NBTE). Three months after the initial operation, redo MVR was performed and aortic valve vegetations were removed. Four days later, the ovarian cancer was resected. Her postoperative course was uneventful and she was discharged on foot on the 143rd day after the initial operation. NBTE caused by malignancy is rare but must be considered when managing endocarditis.