Zea-Vera R, Sanchez M, Castañeda E, Soto-Arquiñigo L
Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru.
Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru; Cardiovascular Surgery Department, Hospital Cayetano Heredia, San Martin de Porres, Lima, Peru.
Case Rep Infect Dis. 2016;2016:4072056. doi: 10.1155/2016/4072056. Epub 2016 Nov 22.
Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for . Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients.
与透析导管相关的心内膜炎是一种必须在每一位出现发热的血液透析患者中怀疑的疾病。多瓣膜疾病是心内膜炎的一种严重并发症，需要采用不同的方式进行处理。关于其治疗的数据非常有限，每个病例都必须单独考虑。我们呈现一位患有这种并发症的患者，并描述其药物治疗和手术处理情况。我们报告一例15岁急性肾衰竭患者，在放置血液透析导管后发生三尖瓣心内膜炎，多次血培养阳性。进行了经食管超声心动图检查，报告显示主动脉瓣和三尖瓣赘生物以及二尖瓣关闭不全。患者通过对三个瓣膜进行手术成功治疗，包括主动脉瓣置换术。关于多瓣膜心内膜炎的恰当治疗的数据有限；在发生心内膜炎且尽管进行了恰当治疗但病情进展缓慢的血液透析患者中考虑这种并发症很重要。在静脉药物滥用不常见的国家，右侧心内膜炎通常与血管导管相关。对于这类患者，积极的手术处理应是首选治疗方法。
