Mizoguchi Hiroki, Sakaki Masayuki, Inoue Kazushige, Yoshioka Yoshiteru, Bito Yasuyuki
Kansai Rousai Hospital, Department of Cardiovascular Surgery, 3-1-69 Inabasou,Amagasaki, Hyogo, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(6):628-30. doi: 10.5761/atcs.cr.11.01664. Epub 2011 Aug 17.
Early diagnosis and treatment of prosthetic valve endocarditis (PVE) is important because it has a high mortality rate. We report a case of PVE which was difficult to diagnose. A 36-year-old man, who had undergone an aortic valve replacement (AVR) 7 years prior, was hospitalized with a high fever of unknown origin. We could not detect a stuck valve, vegetations or abscesses using echocardiography, and the peak aortic transvalvular pressure gradient had increased to 81 mmHg. We suspected PVE and initiated intravenous antibiotic therapy immediately. On day 5, echocardiography demonstrated an abnormal shadow directly under the prosthesis, and we definitively diagnosed PVE and performed an operation. Intraoperatively, the prosthesis was not vegetative, but the left ventricular outflow tract was filled with vegetation that was nearly obstructing it. After dissecting the infectious focus, we performed a re-AVR. Postoperative echocardiography showed that the peak left ventricular aortic pressure gradient decreased to 30 mmHg. Obstructive vegetation is difficult to diagnose by preoperative echocardiography.
人工瓣膜心内膜炎（PVE）的早期诊断和治疗非常重要，因为其死亡率很高。我们报告一例难以诊断的PVE病例。一名36岁男性，7年前接受了主动脉瓣置换术（AVR），因不明原因的高热住院。我们通过超声心动图未检测到瓣膜卡顿、赘生物或脓肿，且主动脉跨瓣峰值压力梯度已升至81 mmHg。我们怀疑为PVE并立即开始静脉抗生素治疗。第5天，超声心动图显示人工瓣膜正下方有异常阴影，我们明确诊断为PVE并进行了手术。术中，人工瓣膜无赘生物，但左心室流出道充满了几乎阻塞它的赘生物。切除感染灶后，我们再次进行了主动脉瓣置换术。术后超声心动图显示左心室主动脉峰值压力梯度降至30 mmHg。术前超声心动图很难诊断阻塞性赘生物。
