Ando M, Sakai A, Nakamura K, Iwata Y, Sanae T
Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Jul;48(7):451-4. doi: 10.1007/BF03218174.
A 39-year-old woman was admitted to our hospital presenting persisting fever. An echocardiographic examination showed severe aortic and mitral valve regurgitation with moderate tricuspid regurgitation. Small left-to-right shunt through the ventricular septal defect was identified. Vegetation was also detected on the tricuspid, mitral, and aortic valves. At one month after admission, the patient showed sudden onset of headache and abdominal pain. A computed tomographic scan demonstrated cerebral and splenic infarction. A pulmonary perfusion scintigram demonstrated perfusion defects in left-S1 and right-S6 regions. At 4 months after admission, as operation was performed. The aortic valve was replaced with a #23 mm CarboMedics prosthesis and the mitral valve with a #29 mm Carbo Medics prosthesis. Tricuspid valve plasty was performed, with closure of He laceration and perforation of the anterior leaflet combined with a commissuroplasty, according to Kay's method. Ventricular septal defect was closed with a bovine pericardial patch. She was discharged at 19 days after the operation, and is leading a good life. Pervasion of the organism seemed to be initiated from the mitral valve which was conveyed by the blood stream to the aortic valve, and to the tricuspid valve through the ventricula septal defect. Left heart evaluation may be important in cases with infective endocarditis and ventricula septal defect.
一名39岁女性因持续发热入住我院。超声心动图检查显示严重的主动脉瓣和二尖瓣反流，伴有中度三尖瓣反流。经检查发现室间隔缺损存在小的左向右分流。在三尖瓣、二尖瓣和主动脉瓣上也检测到赘生物。入院一个月后，患者突然出现头痛和腹痛。计算机断层扫描显示脑梗死和脾梗死。肺灌注闪烁扫描显示左肺上叶尖段（S1）和右肺下叶背段（S6）存在灌注缺损。入院4个月后进行了手术。用23毫米的CarboMedics人工瓣膜替换主动脉瓣，用29毫米的Carbo Medics人工瓣膜替换二尖瓣。根据凯氏方法进行三尖瓣成形术，缝合前叶撕裂和穿孔并结合瓣叶联合部成形术。用牛心包补片关闭室间隔缺损。患者术后19天出院，目前生活良好。病菌感染似乎始于二尖瓣，通过血流传播至主动脉瓣，并经室间隔缺损传播至三尖瓣。对于感染性心内膜炎合并室间隔缺损的病例，左心评估可能很重要。
