Makdisi George, Casciani Thomas, Wozniak Thomas C, Roe David W, Hashmi Zubair A
1 Division of Cardiovascular Surgery, 2 Department of Radiology, 3 Department of Pulmonary and Critical Care, Indiana University Health, Indianapolis, IN 46202, USA.
J Thorac Dis. 2016 Jan;8(1):E137-9. doi: 10.3978/j.issn.2072-1439.2016.01.02.
Timing of surgical management of acute infective endocarditis is a major challenge, with respect to surgical complications, risks of recurrences and optimal valve repair or replacement. We present a case of a 24-year-old male with a history of intravenous drug abuse, who was referred to our center after 10 days of medical management of acute infective endocarditis. Upon arrival he was in septic shock, multi-organ failure, and mobile vegetations on the tricuspid valve with severe tricuspid regurgitation. He also had bilateral pulmonary infarcts and an ischemic stroke in the right parietal lobe. A successful percutaneous transcatheter mechanical vegetation debulking was performed followed by surgical valve replacement seven days later. This case introduces a new option in the management of right-sided endocarditis in critically ill patient, and demonstrates the technical feasibility of a debulking procedure in this setting, which led subsequently to a significant improvement in patient's condition, and he was ultimately able to undergo definitive surgery.
对于急性感染性心内膜炎的外科治疗时机而言，在手术并发症、复发风险以及最佳瓣膜修复或置换方面都是一项重大挑战。我们报告一例24岁有静脉药物滥用史的男性患者，在对急性感染性心内膜炎进行10天的药物治疗后转诊至我们中心。入院时，他处于感染性休克、多器官功能衰竭状态，三尖瓣有活动赘生物伴严重三尖瓣反流。他还患有双侧肺梗死以及右顶叶缺血性卒中。成功进行了经皮经导管机械性赘生物减容术，7天后进行了外科瓣膜置换术。该病例为危重症患者右侧心内膜炎的治疗引入了一种新选择，并证明了在这种情况下减容手术的技术可行性，这随后使患者病情得到显著改善，最终他得以接受确定性手术。
