O'Brien Michael C, Pourmoghadam Kamal K, DeCampli William M
Tex Heart Inst J. 2015 Jun 1;42(3):251-4. doi: 10.14503/THIJ-14-4130. eCollection 2015 Jun.
Prosthetic pulmonary valve endocarditis has infrequently been described outside large cohort reviews, which have typically focused on infections of the left-sided heart valves. Hence, the pathogenesis, clinical presentation, and management principles of prosthetic pulmonary valve endocarditis have not been well differentiated from those of infected aortic and mitral valves. More patients with repaired tetralogy of Fallot are reaching adulthood and will need pulmonary valve implantation. Consequently, a focus on this infrequent but serious cardiac infection is needed, to learn what characteristics might distinguish it from infections of left-sided heart valves. We report the case of a 13-year-old girl with repaired tetralogy of Fallot who presented with fever and nonspecific symptoms. The patient initially failed to meet the Duke criteria for endocarditis but was then found to have endocarditis of her prosthetic pulmonary valve. We explanted the valve and replaced it with a pulmonary homograft, after which the patient had no infectious sequelae. In addition to presenting the patient's case, we review the literature on surgically inserted prosthetic pulmonary valves and discuss the primary management concerns when those valves become infected with endocarditis.
人工肺动脉瓣心内膜炎在大型队列研究之外鲜有报道，这些研究通常聚焦于左侧心脏瓣膜感染。因此，人工肺动脉瓣心内膜炎的发病机制、临床表现和管理原则尚未与感染性主动脉瓣和二尖瓣心内膜炎进行很好的区分。越来越多接受法洛四联症修复术的患者已成年，需要进行肺动脉瓣植入。因此，需要关注这种罕见但严重的心脏感染，以了解其与左侧心脏瓣膜感染的不同特征。我们报告一例13岁法洛四联症修复术后女孩，出现发热和非特异性症状。该患者最初不符合心内膜炎的杜克标准，但随后被发现患有人工肺动脉瓣心内膜炎。我们切除了瓣膜，并用同种异体肺动脉瓣进行替换，术后患者无感染后遗症。除了介绍该患者的病例外，我们还回顾了关于手术植入人工肺动脉瓣的文献，并讨论了这些瓣膜发生感染性心内膜炎时的主要管理问题。
