Huang H-H, Chuang Y-C, Lee K-C, Sue S-H, Chang C-Y, Wei J
Division of Cardiovascular Surgery, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China.
Transplant Proc. 2012 May;44(4):1171-3. doi: 10.1016/j.transproceed.2012.01.095.
The treatment of recurrent prosthetic valve endocarditis is extremely difficult. Heart transplantation (HT) may save the patient's life. Recurrent endocarditis, however, can occur after HT. This report described a patient who had under gone four conventional valve surgeries and three HTs successfully. In May 2000, a 14-year-old boy suffered from endocarditis with severe aortic valve regurgitation. He underwent aortic valve replacement (AVR) at another hospital. Due to prosthetic valve endocarditis, he displayed a severe paravalvular leakage and was transferred to our hospital where he underwent Bentall's operation in October 2000. Despite a full antibiotic course, he experienced a relapse of the prosthetic endocarditis with significant deterioration of the heart function and a progressively more severe paravalvular leak. Considering the difficulties of repair and the poor heart function, he underwent an HT in June 2003 and recovered well. Unfortunately, endocarditis with aortic valve regurgitation attacked him again after 3 years. Remarkably, all blood cultures were negative. A second AVR was performed in October 2006 with a Second Bentall's procedure 1 year later in 2007. In November 2009, the patient suddenly displayed cardiogenic shock with collapse. He was transferred to our hospital and needed extracorporcal membrane oxygenation (ECMO) support. Two days later, he underwent a second HT. However, the donor heart was nonfunctional due to the prolonged ischemia time. ECMO support was continuously needed after the HT. A third HT was performed successfully 10 days later. Due to previous reported experiences of culture-negative endocarditis, minocycline was prescribed twice daily continuously after the third HT/seventh cardiac surgery. The patient was discharged 2 months later. To date he takes minocycline every day and lives a healthy life.
复发性人工瓣膜心内膜炎的治疗极为困难。心脏移植（HT）或许能挽救患者生命。然而，心脏移植后仍可能发生复发性心内膜炎。本报告描述了一名成功接受过四次传统瓣膜手术和三次心脏移植的患者。2000年5月，一名14岁男孩患心内膜炎并伴有严重主动脉瓣反流。他在另一家医院接受了主动脉瓣置换术（AVR）。由于人工瓣膜心内膜炎，他出现了严重的瓣周漏，并被转至我院，于2000年10月接受了Bentall手术。尽管接受了全程抗生素治疗，他仍出现了人工瓣膜心内膜炎复发，心功能显著恶化，瓣周漏也日益严重。考虑到修复困难且心功能较差，他于2003年6月接受了心脏移植，恢复良好。不幸的是，3年后主动脉瓣反流性心内膜炎再次侵袭他。值得注意的是，所有血培养均为阴性。2006年10月进行了第二次主动脉瓣置换术，一年后的2007年又进行了第二次Bentall手术。2009年11月，患者突然出现心源性休克并昏迷。他被转至我院，需要体外膜肺氧合（ECMO）支持。两天后，他接受了第二次心脏移植。然而，由于缺血时间过长，供体心脏无功能。心脏移植后仍持续需要ECMO支持。10天后成功进行了第三次心脏移植。鉴于既往有培养阴性的心内膜炎报道，第三次心脏移植/第七次心脏手术后，每天两次给予米诺环素。患者两个月后出院。迄今为止，他每天服用米诺环素，生活健康。
