Doi Toshio, Gyoten Takayuki, Sakata Kimimasa, Nagura Saori, Yamashita Akio, Fukahara Kazuaki, Kotoh Keiju, Yoshimura Naoki
Department of Cardiovascular Surgery, JA Nagano Koseiren Shinonoi General Hospital, Nagano, Japan.
Kyobu Geka. 2016 Jul;69(7):537-40.
Isolated pulmonary valve endocarditis is an extremely rare clinical condition. Here, we report a case of pulmonary valve endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). An 84-year-old man with a history of aortic regurgitation and patent foramen ovale was admitted to our hospital due to fever of unknown origin for 4 weeks' duration. MRSA was detected in his blood cultures. Transthoracic echocardiography demonstrated a mobile vegetation attached to the pulmonary valve, moderate to severe aortic regurgitation, and patent foramen ovale with left-to-right shunt. After 30-days' treatment with vancomycin, gentamicin and rifampicin, he defervesced and blood cultures became negative. At surgery, a large vegetation was still attached to the pulmonary valve, but the leaflets remained with minimum damage. Aortic valve replacement, direct closure of the patent foramen ovale, and simple resection of the vegetation were performed. The postoperative course was uneventful.
孤立性肺动脉瓣心内膜炎是一种极其罕见的临床病症。在此,我们报告一例由耐甲氧西林金黄色葡萄球菌(MRSA)引起的肺动脉瓣心内膜炎病例。一名84岁男性,有主动脉瓣反流和卵圆孔未闭病史,因持续4周不明原因发热入住我院。血培养检测出MRSA。经胸超声心动图显示肺动脉瓣上有一个活动的赘生物,中度至重度主动脉瓣反流,以及卵圆孔未闭伴左向右分流。经万古霉素、庆大霉素和利福平治疗30天后,他体温恢复正常,血培养转阴。手术时,肺动脉瓣上仍附着有一个大的赘生物,但瓣叶损伤最小。进行了主动脉瓣置换、卵圆孔未闭直接闭合以及赘生物简单切除。术后过程顺利。