Dapás Juan Ignacio, Rivero Cynthia, Burgos Pablo, Vila Andrea
Department of Infectious Diseases, Hospital Italiano de Mendoza, Argentina.
Department of Cardiovascular Surgery, Hospital Italiano de Mendoza, Argentina.
Open Cardiovasc Med J. 2016 Feb 19;10:28-34. doi: 10.2174/1874192401610010028. eCollection 2016.
Transcatheter aortic valve implantation (TAVI) is an alternative treatment for severe aortic valve stenosis (AS) in patients with prohibitive risk for surgical aortic valve replacement (SAVR). Prosthetic valve endocarditis (PVE) is a rare complication of this relatively novel procedure and current guidelines do not include specific recommendations for its treatment. We report a case of PVE due to Pseudomonas aeruginosa after TAVI that required SAVR, with successful outcome. PVE usually occurs during the first year after TAVI and entails a high mortality risk because patients eligible for this min-imally invasive procedure are fragile (i.e. advanced age and/or severe comorbidities). Additionally, clinical presentation may be atypical or subtle and transesophageal echocardiogram (TEE) may not be conclusive, which delays diagnosis and treatment worsening the prognosis. This case highlights that open SAVR might be ultimately indicated as part of treatment for TAVI-PVE despite a high-risk surgery score.
经导管主动脉瓣植入术（TAVI）是手术主动脉瓣置换术（SAVR）风险过高的严重主动脉瓣狭窄（AS）患者的一种替代治疗方法。人工瓣膜心内膜炎（PVE）是这种相对新颖的手术的一种罕见并发症，目前的指南并未包括针对其治疗的具体建议。我们报告了1例TAVI术后因铜绿假单胞菌引起的PVE病例，该病例需要进行SAVR，结果成功。PVE通常发生在TAVI后的第一年，由于适合这种微创手术的患者身体虚弱（即高龄和/或严重合并症），因而具有较高的死亡风险。此外，临床表现可能不典型或不明显，经食管超声心动图（TEE）可能无法确诊，这会延误诊断和治疗，从而使预后恶化。该病例突出表明，尽管手术风险评分很高，但对于TAVI-PVE的治疗，开放SAVR最终可能仍是必要的一部分。
