Miura Takashi, Eishi Kiyoyuki, Hashizume Koji, Taniguchi Shinichiro, Tanigawa Kazuyoshi, Izumi Kenta
Department of Cardiovascular Surgery, Graduate School of Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Gen Thorac Cardiovasc Surg. 2010 Jan;58(1):49-52. doi: 10.1007/s11748-009-0479-0. Epub 2010 Jan 9.
A 22-year-old man was diagnosed with active mitral endocarditis 14 months after mitral valve repair. The responsible organism was methicillin-resistant Staphylococcus epidermidis. Transthoracic echocardiography showed an 8-mm patch of vegetation adhering to the anterior part of the artificial ring. Although antibiotics (piperacillin, minocycline, imipenem/cilastatin, and ampicillin) were administered, the vegetation grew to 30 mm. Reoperation was performed 35 days after the diagnosis. Before surgery, there was mild mitral regurgitation without congestive heart failure. Re-repair was performed by removing the vegetation and the artificial ring, and mattress sutures repaired the circumferential sulcus formed by the artificial ring. Teicoplanin and minocycline were administered for 6 weeks. At 20 months, infective endocarditis was absent. Residual mitral regurgitation has been consistently mild. Although active mitral endocarditis after mitral valve repair is rare, prompt reoperation should be considered if the responsible organism is drug-resistant and infection spreads to the artificial ring.
一名22岁男性在二尖瓣修复术后14个月被诊断为活动性二尖瓣心内膜炎。病原菌为耐甲氧西林表皮葡萄球菌。经胸超声心动图显示一块8毫米的赘生物附着在人工瓣环前部。尽管使用了抗生素（哌拉西林、米诺环素、亚胺培南/西司他丁和氨苄西林），但赘生物长到了30毫米。诊断后35天进行了再次手术。手术前，存在轻度二尖瓣反流但无充血性心力衰竭。再次修复是通过切除赘生物和人工瓣环，并用褥式缝线修复由人工瓣环形成的圆周沟。给予替考拉宁和米诺环素6周。20个月时，无感染性心内膜炎。残留二尖瓣反流一直较轻。尽管二尖瓣修复术后活动性二尖瓣心内膜炎很少见，但如果病原菌耐药且感染扩散到人工瓣环，应考虑及时再次手术。
