Sarsam Sinan, Kaspar Georgy, David Shukri, Zughaib Marcel
Department of Cardiology, Providence Hospital and Medical Centers, Michigan State University, Southfield, MI, USA.
Department of Cardiology,, Providence Hospital and Medical Centers, Michigan State University, Southfield, MI, USA.
Am J Case Rep. 2017 Jun 14;18:665-668. doi: 10.12659/ajcr.903071.
BACKGROUND The CardioMEMS Heart Failure System is a well validated tool to optimize management of systolic and diastolic heart failure and has been shown to reduce the risk of hospitalization by 37%. We are reporting a unique case of acute aortic valve insufficiency as a first sign of endocarditis, detected early in a patient with the CardioMEMS device. CASE REPORT A 79-year-old man with dual bioprosthetic mitral and aortic valve replacement and non-ischemic cardiomyopathy had a CardioMEMS Heart Failure System implanted 2 months following valve replacement surgery. The CardioMEMS System detected a gradual but steady increase in the pulmonary artery pressures while the patient was completely asymptomatic. A transthoracic echocardiogram demonstrated evidence of severe aortic valve regurgitation and mobile vegetation. The diagnosis of infective endocarditis was made with evidence of methicillin-sensitive Staphylococcus aureus bacteremia and involvement of the bioprosthetic aortic valve. The patient ultimately underwent treatment with intravenous antibiotics and redo aortic valve replacement. CONCLUSIONS While the CardioMEMS Heart Failure System is effective in reducing readmission rates for patients with class III heart failure, it can detect early hemodynamic changes from conditions other than congestive heart failure. Our case illustrated the CardioMEMS-assisted early diagnosis of infective endocarditis prior to clinical deterioration.
CardioMEMS心力衰竭系统是一种经过充分验证的工具，可优化收缩性和舒张性心力衰竭的管理，并已证明可将住院风险降低37%。我们报告了一例独特的病例，一名植入CardioMEMS设备的患者早期检测到急性主动脉瓣关闭不全作为心内膜炎的首发症状。病例报告：一名79岁男性，接受了二尖瓣和主动脉瓣双生物瓣置换术以及非缺血性心肌病治疗，在瓣膜置换手术后2个月植入了CardioMEMS心力衰竭系统。在患者完全无症状的情况下，CardioMEMS系统检测到肺动脉压力逐渐但稳定地升高。经胸超声心动图显示存在严重主动脉瓣反流和活动赘生物。根据甲氧西林敏感金黄色葡萄球菌菌血症及生物瓣主动脉瓣受累的证据，诊断为感染性心内膜炎。患者最终接受了静脉抗生素治疗及再次主动脉瓣置换术。结论：虽然CardioMEMS心力衰竭系统在降低III级心力衰竭患者的再入院率方面有效，但它可以检测到除充血性心力衰竭以外的其他疾病引起的早期血流动力学变化。我们的病例说明了CardioMEMS辅助在临床恶化之前对感染性心内膜炎进行早期诊断。
