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左心室游离壁霉菌性动脉瘤并发主动脉瓣心内膜炎

[Mycotic aneurysm of the left ventricular free wall complicating aortic valve endocarditis].

作者信息

Correia Emanuel, Almeida Jorge, Madureira António J, Monteiro Vítor

机构信息

Serviços de Cirurgia Cardiotorácia e Radiologia, Hospital de S. João, Porto, Portugal.

出版信息

Rev Port Cardiol. 2012 Jan;31(1):31-4. doi: 10.1016/j.repc.2011.10.010. Epub 2011 Dec 6.

Abstract

We report the case of a 34-year-old man with aortic valve infective endocarditis caused by methicillin-resistant Staphylococcus aureus, complicated by an aortic annular abscess. A 23-mm St. Jude HP aortic mechanical prosthesis was implanted. The pre-discharge echocardiogram revealed a mycotic aneurysm of the basal posteroinferior wall, confirmed by cardiac magnetic resonance imaging, and it was decided to reintervene. The aneurysm was closed with a patch and the mitral valve had to be replaced. Although a small leak from the aneurysm patch persisted on the pre-discharge transthoracic echocardiogram, there was no trace of the aneurysm at nine-month re-evaluation. This case illustrates a rare complication of aortic valve endocarditis and shows the evolution of the mycotic aneurysm after closure via a transmitral approach.

摘要

我们报告了一例34岁男性,患有由耐甲氧西林金黄色葡萄球菌引起的主动脉瓣感染性心内膜炎,并伴有主动脉瓣环脓肿。植入了一个23毫米的圣犹达HP主动脉机械瓣膜。出院前的超声心动图显示基底后下壁有一个真菌性动脉瘤,经心脏磁共振成像证实,因此决定再次进行干预。用补片封闭了动脉瘤,并且不得不更换二尖瓣。尽管出院前经胸超声心动图显示动脉瘤补片有少量渗漏,但在九个月的复查中动脉瘤已无踪迹。该病例说明了主动脉瓣心内膜炎一种罕见的并发症,并展示了经二尖瓣途径封闭后真菌性动脉瘤的演变过程。

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