Hori Daijiro, Noguchi Kenichiro, Nomura Yohei, Tanaka Hiroyuki
Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Yokohama, Kanagawa, Japan.
Ann Thorac Cardiovasc Surg. 2012;18(3):262-5. doi: 10.5761/atcs.cr.11.01750.
A 62-year-old man with a medical history of aortic valve replacement was referred to our hospital with high-grade fever. Blood culture was positive for Streptococcus dysgalactiae, and the echocardiogram showed edematous aortic annulus, suggesting a perivalvular abscess. Treatment with antibiotics was started, which showed progressive improvement. The echocardiogram at 2 weeks after admission showed progression of the perivalvular abscess, resulting in the formation of a perivalvular pseudoaneruysm, which revealed rapid enlargement. The patient underwent surgical resection of a 20-mm pseudoaneurysm, originating from the right and left coronary cusp. Complete resection of the infective tissue was performed, and an aortic root replacement was done. This case highlights that a frequent follow-up should be performed in case of perivalvular abscess, because of the risk of pseudoaneurysm formation, which may cause a life-threatening outcome.
一名有主动脉瓣置换病史的62岁男性因高热被转诊至我院。血培养结果显示停乳链球菌阳性，超声心动图显示主动脉瓣环水肿，提示瓣周脓肿。开始使用抗生素治疗，病情逐渐好转。入院2周后的超声心动图显示瓣周脓肿进展，形成瓣周假性动脉瘤，且迅速增大。患者接受了起源于左右冠状动脉瓣叶的20毫米假性动脉瘤的手术切除。对感染组织进行了彻底切除，并进行了主动脉根部置换。该病例强调，对于瓣周脓肿患者，应频繁进行随访，因为存在假性动脉瘤形成的风险，这可能导致危及生命的后果。
