Stagaman D J, Presti C, Rees C, Miller D D
Department of Medicine (Cardiology) and Radiology, University of Texas Health Science Center, San Antonio 78284-7872.
Chest. 1990 Jun;97(6):1484-6. doi: 10.1378/chest.97.6.1484.
Right-sided valvular (tricuspid, pulmonic) endocarditis is frequently complicated by septic pulmonary embolization. Systemic embolization may also rarely occur due to associated left-sided endocarditis or right-to-left shunting in patients with septal defects. This report documents the occurrence of systemic embolization causing a cerebrovascular accident in an intravenous drug abuser with recurrent tricuspid valve endocarditis due to an isolated peripheral septic pulmonary arteriovenous fistula. Noninvasive diagnosis of the fistula by cardiac auscultation, contrast echocardiography, and nuclear magnetic resonance imaging was confirmed by selective pulmonary angiography. Subselective balloon embolization of the pulmonary arteries feeding this fistula was accomplished.
右侧瓣膜（三尖瓣、肺动脉瓣）心内膜炎常并发感染性肺栓塞。由于合并左侧心内膜炎或存在间隔缺损的患者出现右向左分流，系统性栓塞也可能很少发生。本报告记录了一名静脉药物滥用者因孤立的外周感染性肺动静脉瘘导致复发性三尖瓣心内膜炎，进而发生系统性栓塞并引发脑血管意外的病例。通过心脏听诊、对比超声心动图和核磁共振成像对瘘管进行无创诊断，并经选择性肺动脉造影得以证实。对供应该瘘管的肺动脉进行了亚选择性球囊栓塞。
