难治性人工瓣膜心内膜炎需要反复重建：治疗选择有限。

Recalcitrant prosthetic valve endocarditis requiring repeated reconstruction: running out of options.

机构信息

Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada.

Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Microbiology and Immunology, Schulich School of Medicine, Western University, London, Ontario, Canada.

出版信息

Can J Cardiol. 2014 Dec;30(12):1732.e5-8. doi: 10.1016/j.cjca.2014.09.003. Epub 2014 Sep 6.

DOI:10.1016/j.cjca.2014.09.003

PMID:25475479

Abstract

In this report we describe a previously healthy 36-year-old man who presented with septic shock secondary to bacterial endocarditis with multiple cerebral, mesenteric, and peripheral embolic phenomena. He underwent emergent porcine prosthetic valve replacement with aortic annular reconstruction. Subsequently, he developed recalcitrant Candida parapsilosis endocarditis requiring treatment with multiple antifungal agents and 4 repeated complex reconstructions of the aortic root and fibrous trigones over 3 years, before the infection was successfully controlled. This case underscores the significant morbidity associated with fungal endocarditis and importance of an early combined medical and surgical approach.

摘要

在本报告中，我们描述了一例先前健康的 36 岁男性，因细菌性心内膜炎并发多发性脑、肠系膜和外周栓塞而出现感染性休克。他接受了紧急猪瓣置换术和主动脉瓣环重建术。随后，他发生了难治性近平滑假丝酵母菌心内膜炎，需要使用多种抗真菌药物治疗，并在 3 年内经历了 4 次复杂的主动脉根部和纤维三角重建，最终感染得到了控制。该病例强调了真菌性心内膜炎相关的高发病率以及早期采用综合内科和外科治疗方法的重要性。