Abdelbar Abdelrahmen, Azzam Raed, Yap Kok Hooi, Abousteit Ahmed
Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
Case Rep Surg. 2013;2013:746589. doi: 10.1155/2013/746589. Epub 2013 Sep 9.
We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT) obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.
我们报告一例53岁男性,其表现为严重脓毒症。入院前他作为肺炎患者接受了5个月的治疗。检查发现除未诊断出的右心室流出道(RVOT)梗阻外,还存在孤立性肺动脉瓣心内膜炎和脓毒性肺栓塞。患者接受了手术,通过对RVOT进行大量肌肉切除、肺动脉栓子切除术、肺动脉瓣置换以及用两片单独的牛心包补片重建RVOT和主肺动脉来缓解RVOT梗阻。在静脉使用抗生素6周后,他从我院出院。出院后16周的随访中他恢复良好。诊断右侧心内膜炎需要高度怀疑指数。血培养和经食管超声心动图是关键的诊断工具。