Brehm Bernhard R, Franz Marcus
Department of Cardiology, University of Jena, Jena, Germany.
BMJ Case Rep. 2011 Apr 13;2011:bcr1020092326. doi: 10.1136/bcr.10.2009.2326.
A 73-year-old male was admitted due to sepsis with fever up to 40°C after haemorrhoidectomy. Blood cultures identified Staphylococcus haemolyticus. In 1986 he developed left ventricular aneurysm containing an apical thrombus after anterior wall myocardial infarction. In 1994 aorto-coronary bypass grafting was performed without thrombus removal. Echocardiography on admission showed a thrombus formation in the apical aneurysm. In the thrombus an inhomogeneous floating structure in terms of an abscess was identified. Later, a small perforation occurred at the border of the thrombus. Vancomycin and Tygacil were given for 20 days. Repeated echocardiographies showed a thrombus liquefaction and disaggregation after 12 days. Finally, a territorial haemopericardium with residual thrombus developed. Infection of a ventricular thrombus by septicaemia with myocardial wall infiltration by haemolysing Staphylococcus is rare but can result in spontaneous ventricle perforation. The patient survived and is after 18 months alive suffering form heart failure NYHA class II-III.
一名73岁男性在痔切除术后因败血症伴高达40°C的发热入院。血培养鉴定出溶血葡萄球菌。1986年，他在前壁心肌梗死后形成了含有心尖血栓的左心室室壁瘤。1994年进行了主动脉冠状动脉搭桥术，未清除血栓。入院时的超声心动图显示心尖室壁瘤内有血栓形成。在血栓中发现了一个不均匀的漂浮结构，考虑为脓肿。后来，血栓边缘出现了一个小穿孔。给予万古霉素和替加环素治疗20天。重复超声心动图显示12天后血栓液化和崩解。最后，出现了伴有残留血栓的局限性心包积血。由败血症引起的心室血栓感染伴溶血葡萄球菌心肌壁浸润很少见，但可导致自发性心室穿孔。患者存活，18个月后仍存活，患有纽约心脏病协会（NYHA）II-III级心力衰竭。
