Yamamoto Naoki, Fujii Taro, Kogure Shuhei, Watanabe Fumiaki, Yuasa Uhito, Tokui Toshiya, Okada Yukikatsu
Department of Thoracic Surgery, Japanese Red Cross Society Yamada Red Cross Hospital, Ise, Japan.
Kyobu Geka. 2012 Apr;65(4):301-5.
We report a surgically treated case of tricuspid valve endocarditis. A 33-year-old man was diagnosed with ventricular septal defect (VSD) and active infective endocarditis associated with severe tricuspid regurgitation. Ultrasonic echocardiography (UCG) showed vegetations attached to the tricuspid valve. His blood culture was positive for Streptococcus oralis. Although intravenous antibiotics therapy was effective, chest computed tomography( CT) revealed multiple septic pulmonary enboli in right lung and UCG showed severe tricuspid valve regurgitation. So we performed tricuspid valve repair by reconstructing septal leaflet using an autologous pericardium, expanded polytetrafluoroethylene( ePTFE) artificial chordae and annuloplasty ring. The postoperative course was uneventful, without tricuspid regurgitation or stenosis. He has been free from any complication for over 8 months. This surgical technique of tricuspid valve repair with an autologous pericardium and ePTFE artificial chordae for infective endocarditis might be useful choice of procedure for patients with leaflet destruction, in particular for young patients because of less recurrence of infection, less chance of anticoagulant therapy and expected long uneventful course.
我们报告一例经手术治疗的三尖瓣心内膜炎病例。一名33岁男性被诊断为室间隔缺损（VSD）以及伴有严重三尖瓣反流的活动性感染性心内膜炎。超声心动图（UCG）显示三尖瓣上附着有赘生物。他的血培养结果显示口腔链球菌呈阳性。尽管静脉注射抗生素治疗有效，但胸部计算机断层扫描（CT）显示右肺有多个脓毒性肺栓塞，且UCG显示严重的三尖瓣反流。因此，我们使用自体心包、膨体聚四氟乙烯（ePTFE）人工腱索和瓣环成形环重建隔叶，对三尖瓣进行了修复。术后过程顺利，无三尖瓣反流或狭窄。他已超过8个月未出现任何并发症。这种采用自体心包和ePTFE人工腱索修复感染性心内膜炎三尖瓣的手术技术，对于瓣叶破坏的患者可能是一种有用的手术选择，特别是对于年轻患者，因为感染复发较少、抗凝治疗机会较少且预期病程平稳且长久。
