Moazez Carmel, Zeitjian Vicken, Breburda Christian, Roy Ranjini
Maricopa Integrated Health System, 2601 E. Roosevelt St., Phoenix, AZ 85008, USA.
Case Rep Cardiol. 2017;2017:7630915. doi: 10.1155/2017/7630915. Epub 2017 Oct 25.
Ebstein's anomaly is a rare congenital heart disease that presents with apical displacement of the septal and posterior leaflets of the tricuspid valve. It has a wide spectrum of clinical presentations and has been shown to manifest itself any time from birth to adulthood. Our patient is a 43-year-old male with a history of intravenous heroin abuse who presented to the emergency department with worsening shortness of breath and lower extremity edema. He denied any prior cardiac history. A transthoracic echo showed normal left ventricular function, but a large 2.2 × 2.1 cm echodensity on the septal leaflet of the tricuspid valve consistent with vegetation with severe tricuspid regurgitation and probable leaflet perforation. It also demonstrated severe right heart enlargement with atrialization of the right ventricle and apical displacement of the tricuspid valve consistent with Ebstein's anomaly. This is a rare case of an adult who presented with asymptomatic Ebstein's anomaly. There have been few reports of tricuspid valve endocarditis with Ebstein's anomaly in the literature. To our knowledge, this represents the fifth reported case of a new diagnosis of Ebstein's anomaly in the setting of endocarditis and the second case of Ebstein's anomaly and endocarditis in an intravenous drug abuser.
埃布斯坦畸形是一种罕见的先天性心脏病，表现为三尖瓣隔叶和后叶的顶端移位。它有广泛的临床表现，已被证明在从出生到成年的任何时候都可能出现。我们的患者是一名43岁男性，有静脉注射海洛因滥用史，因呼吸急促加重和下肢水肿就诊于急诊科。他否认有任何既往心脏病史。经胸超声心动图显示左心室功能正常，但三尖瓣隔叶上有一个2.2×2.1厘米的大回声密度，符合赘生物，伴有严重的三尖瓣反流和可能的瓣叶穿孔。它还显示右心严重扩大，右心室心房化，三尖瓣顶端移位，符合埃布斯坦畸形。这是一例表现为无症状埃布斯坦畸形的成人罕见病例。文献中关于埃布斯坦畸形合并三尖瓣心内膜炎的报道很少。据我们所知，这是第五例在感染性心内膜炎背景下新诊断为埃布斯坦畸形的报道病例，也是静脉药物滥用者中埃布斯坦畸形合并感染性心内膜炎的第二例。
