一名透析患者合并二尖瓣瓣周脓肿及左心室-心房瘘
Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis.
作者信息
Kitamura Tadashi, Edwards James, Khurana Suchi, Stuklis Robert G
机构信息
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide SA, Australia.
出版信息
J Cardiothorac Surg. 2009 Jul 16;4:35. doi: 10.1186/1749-8090-4-35.
BACKGROUND
Infective endocarditis in hemodialysis patients is challenging but is becoming more common recently.
CASE REPORT
A 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully.
CONCLUSION
Timely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease.
背景
血液透析患者的感染性心内膜炎具有挑战性，但近年来越来越常见。
病例报告
一名64岁的终末期肾病血液透析患者，在开始家庭血液透析训练后出现二尖瓣感染性心内膜炎和冠状动脉疾病。在抗生素治疗过程中，患者因二尖瓣瓣周脓肿形成左心室-心房瘘。成功进行了脓肿清创，随后用新鲜自体心包补片重建二尖瓣环，并使用机械瓣膜置换二尖瓣，同时进行冠状动脉旁路移植术。
结论
及时诊断、适当的抗生素治疗以及包括积极清创在内的早期手术干预应能改善这种高危疾病的治疗效果。
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