Connelly Tara, Siddiqui Sadiq, Kolcow Walenty, Veerasingam Dave
Department of Surgery, Galway University Hospital, Galway, Ireland.
Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland.
BMJ Case Rep. 2015 Nov 4;2015:bcr2015211772. doi: 10.1136/bcr-2015-211772.
We present a case of a 44-year-old woman who presented with cough, pleuritic chest pain and fever leading to a diagnosis of pneumonia±pulmonary embolism. She had a history of familial hypertrophic obstructive cardiomyopathy (HOCM), for which an automated implantable cardioverter defibrillator (AICD) had been implanted, and a subsequent superior vena cava (SVC) thrombus, for which she was anticoagulated with warfarin. On admission, blood cultures grew a coagulase-negative Staphylococcus. CT pulmonary angiogram and transoesophageal echocardiography (TOE) were performed and revealed large vegetations adherent to the AICD leads with complete occlusion of the SVC. The infected leads were the source of sepsis. Open surgery was planned. For cardiopulmonary bypass, the venous cannula was inserted in the inferior vena cava (IVC) and a completely bloodless field was obtained in the right atrium allowing for the extraction of the AICD leads completely, along with the adherent vegetations from within.
我们报告一例44岁女性病例，该患者因咳嗽、胸膜炎性胸痛和发热就诊，诊断为肺炎±肺栓塞。她有家族性肥厚性梗阻性心肌病（HOCM）病史，为此植入了自动植入式心脏复律除颤器（AICD），随后出现上腔静脉（SVC）血栓，她接受了华法林抗凝治疗。入院时，血培养培养出凝固酶阴性葡萄球菌。进行了CT肺动脉造影和经食管超声心动图（TOE）检查，结果显示AICD导线附着有大量赘生物，SVC完全闭塞。感染的导线是脓毒症的来源。计划进行开放手术。对于体外循环，将静脉插管插入下腔静脉（IVC），在右心房获得完全无血的视野，以便完全取出AICD导线以及内部附着的赘生物。
