Saito Masahito, Asano Naoki, Ota Kazunori, Niimi Kazuho, Tanaka Koyu, Gon Shigeyoshi, Takano Hiroshi
Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
Kyobu Geka. 2016 Dec;69(13):1067-1071.
A 52-year-old woman was admitted to our hospital for acute right hemi-paresis, left homonymous hemianopia, and fever. Magnetic resonance imaging of the brain showed multiple cerebral infarctions and transesophageal echocardiography (TEE) revealed a vegetation on the posterior leaflet of her mitral valve. Mitral valve repair was performed under a diagnosis of infective endocarditis (IE). Further multiple cerebral infarctions occurred on the 11th postoperative day, resulting in left hemiplegia and dysarthria. TEE revealed vegetations on her mitral valve and mitral valve replacement (MVR) was performed. Microscopic examination of the resected valve showed mild lymphocytic infiltration, but no bacterial or fungal organisms were detected. On the 66th day after the initial surgery, she developed deep vein thrombosis and acute pulmonary embolism. Abdominal computed tomography showed a huge ovarian tumor, and TEE demonstrated vegetations on the left atrial wall, the aortic valve, and the mechanical valve immobilizing one of the leaflets. The patient was finally diagnosed as having Trousseau syndrome caused by an ovarian tumor and non-bacterial thrombotic endocarditis( NBTE). Three months after the initial operation, redo MVR was performed and aortic valve vegetations were removed. Four days later, the ovarian cancer was resected. Her postoperative course was uneventful and she was discharged on foot on the 143rd day after the initial operation. NBTE caused by malignancy is rare but must be considered when managing endocarditis.
一名52岁女性因急性右侧偏瘫、左侧同向性偏盲和发热入住我院。脑部磁共振成像显示多发性脑梗死，经食管超声心动图（TEE）显示其二尖瓣后叶有赘生物。在诊断为感染性心内膜炎（IE）的情况下进行了二尖瓣修复术。术后第11天又发生多发性脑梗死，导致左侧偏瘫和构音障碍。TEE显示二尖瓣有赘生物，遂进行二尖瓣置换术（MVR）。对切除瓣膜的显微镜检查显示有轻度淋巴细胞浸润，但未检测到细菌或真菌。初次手术后第66天，她发生了深静脉血栓形成和急性肺栓塞。腹部计算机断层扫描显示有一个巨大的卵巢肿瘤，TEE显示左心房壁、主动脉瓣和机械瓣膜的一个瓣叶上有赘生物。该患者最终被诊断为由卵巢肿瘤和非细菌性血栓性心内膜炎（NBTE）引起的Trousseau综合征。初次手术后三个月，再次进行MVR并切除主动脉瓣赘生物。四天后，切除卵巢癌。她的术后过程顺利，初次手术后第143天步行出院。由恶性肿瘤引起的NBTE很少见，但在处理心内膜炎时必须予以考虑。
