Desaint Paul, Chauvat Anthony, Garaud Thomas, Andremont Olivier, Plantefève Gaëtan, Mentec Hervé, Contou Damien
Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
Service de Cardiologie, Centre Hospitalier Victor Dupouy, Argenteuil, France.
Heart Lung Circ. 2018 Mar;27(3):e34-e37. doi: 10.1016/j.hlc.2017.10.013. Epub 2017 Oct 31.
Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism.
We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity.
A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis. A few hours after admission, an unexpected cardiac arrest occurred. Chest computed tomographic-scan and transoesophageal echocardiography revealed a pericardial effusion due to a perivalvular mitral abscess fistulised toward the pericardial cavity. Despite prompt management including surgical debridement and appropriate antibiotics, death occurred 36hours after intensive care admission. All blood cultures as well as native mitral valve and pericardial fluid grew methicillin-sensitive Staphylococcus aureus.
Intensivists should consider this rare complication in patients with staphylococcal infective endocarditis and perivalvular abscess.
感染性心内膜炎期间，心包腔瘘是瓣周脓肿一种非常罕见的并发症，金黄色葡萄球菌是最常相关的微生物。
我们报告一例因二尖瓣心内膜炎导致的致命性感染性休克，该心内膜炎由心肌脓肿向心包腔破溃引发。
一名66岁无既往瓣膜病的女性因严重脓毒症入住重症监护病房。入院数小时后发生意外心脏骤停。胸部计算机断层扫描和经食管超声心动图显示因二尖瓣瓣周脓肿向心包腔破溃导致心包积液。尽管采取了包括手术清创和恰当抗生素在内的及时治疗措施，患者在入住重症监护病房36小时后死亡。所有血培养以及天然二尖瓣和心包积液培养均生长出对甲氧西林敏感的金黄色葡萄球菌。
重症监护医生应在患有葡萄球菌性感染性心内膜炎和瓣周脓肿的患者中考虑这种罕见并发症。
