Myerson Merle, Armstrong Ehrin J, Poltavskiy Eduard, Fefer Jose, Bang Heejung
Tex Heart Inst J. 2016 Dec 1;43(6):514-516. doi: 10.14503/THIJ-15-5354. eCollection 2016 Dec.
Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery.
对于既往感染性心内膜炎继发的严重三尖瓣反流，手术干预并不常见，尤其是在同时感染人类免疫缺陷病毒（HIV）的患者中。我们描述了一名62岁的HIV阳性男性病例，他有因静脉注射海洛因导致的心内膜炎病史24年，出现了严重的三尖瓣反流。患者最初无症状，正在服用抗逆转录病毒药物，CD4计数令人满意且病毒载量检测不到，因此我们决定对反流进行保守治疗。两年后，他出现双心室心力衰竭和呼吸困难。在进行三尖瓣置换手术后，他的病情有了显著改善。该病例表明，患有复杂医疗状况的HIV感染患者可以成功接受心脏手术。
