Koike S, Takayama S, Furihata A, Furihata Y, Sasaki Y, Furuta S, Morimoto M
Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Jpn Circ J. 1991 Dec;55(12):1228-32. doi: 10.1253/jcj.55.1228.
An extremely unusual case of myocardial infarction associated with infective endocarditis (IE) is described. A 38-year old male with a high fever was transferred to our hospital for further treatment of IE. Two-dimensional echocardiogram showed a large mycotic aneurysm of the sinus of Valsalva in contact with neighbouring structures. The patient had a rapid recovery within several days after administration of antibiotic agents. However, he then developed abrupt onset of severe precordial pain. From the echocardiogram images and biochemical evaluation he was diagnosed as having an acute subendocardial infarction. Serial echocardiograms revealed expansion of the aneurysm, extending from the myocardium of the anterolateral free wall to the lower margin of the proximal left coronary artery. The cause of acute myocardial infarction was thought to be incomplete occlusion of the coronary artery through compression by the enlarging mycotic aneurysm of the sinus of Valsalva. Urgent surgery confirmed compression of the left coronary artery by the large mycotic aneurysm as the cause of acute myocardial infarction.
本文描述了一例极其罕见的与感染性心内膜炎（IE）相关的心肌梗死病例。一名38岁高热男性因IE转至我院进一步治疗。二维超声心动图显示一个巨大的瓦氏窦霉菌性动脉瘤，与邻近结构相连。患者在使用抗生素治疗数天内迅速康复。然而，随后他突然出现严重的心前区疼痛。根据超声心动图图像和生化评估，他被诊断为急性心内膜下梗死。系列超声心动图显示动脉瘤扩大，从前外侧游离壁心肌延伸至左冠状动脉近端下缘。急性心肌梗死的原因被认为是瓦氏窦不断增大的霉菌性动脉瘤压迫导致冠状动脉不完全闭塞。紧急手术证实，巨大的霉菌性动脉瘤压迫左冠状动脉是急性心肌梗死的原因。
