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A 68-year-old man was referred to our hospital with infectious endocarditis (IE) of the mitral valve complicated by mycotic aneurysms located in the right middle cerebral artery (MCA) and the superior mesenteric artery (SMA). After coil embolization of the SMA aneurysm during angiography, surgical treatment of the MCA aneurysm was carried out. Antibiotic therapy for Enterococcus faecalis was continued throughout this period. After his IE was controlled, mitral valve repair was performed. The old vegetation on the edge of the anterior leaflet was resected and the defect was covered by transferring the posterior leaflet using the flip-over technique. Since there is no agreement about the optimum treatment of IE associated with multiple mycotic aneurysms, it is important to carefully plan the management of individual cases.
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