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经导管主动脉瓣置换术后急性感染性心内膜炎的外科治疗

[Surgical Treatment of Acute Infective Endocarditis after Transcatheter Aortic Valve Replacement].

作者信息

Ohori Shunsuke, Fujita Kishu, Morimoto Kiyotaka, Suzuki Masato, Baba Toshio, Yokoyama Hideo, Nomura Fumikazu, Ohkawa Youhei, Sugiki Kenji, Ohno Takemi

机构信息

Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan.

出版信息

Kyobu Geka. 2018 Oct;71(11):929-931.

Abstract

Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a rare complication, but has a high mortality. An 86-year-old female with symptomatic severe aortic stenosis underwent TAVR at our hospital and she was discharged without complication after 10 days. She was readmitted with high fever and acute heart failure 1 month later. Blood culture revealed Staphylococcus, and echocardiography showed vegetation on the septal cusp of the tricuspid valve and perforation at the membranous ventricular septum. We decided to perform emergency operation due to active infection and intracardiac complication despite appropriate antibiotic treatment. The infected valve was replaced with a bioprosthetic valve and the right ventricular (RV)-left ventricular (LV) communication was closed with a bovine pericardial patch. The patient received the antibiotics for 6 week and was transferred to the previous facility.

摘要

经导管主动脉瓣置换术(TAVR)后感染性心内膜炎(IE)是一种罕见的并发症,但死亡率很高。一名86岁有症状的重度主动脉瓣狭窄女性在我院接受了TAVR,术后10天无并发症出院。1个月后,她因高热和急性心力衰竭再次入院。血培养显示为葡萄球菌,超声心动图显示三尖瓣隔叶有赘生物,室间隔膜部穿孔。尽管进行了适当的抗生素治疗,但由于存在活动性感染和心内并发症,我们决定进行急诊手术。用生物人工瓣膜替换感染的瓣膜,并用牛心包补片封闭右心室(RV)-左心室(LV)通道。患者接受了6周的抗生素治疗,随后转至之前的医疗机构。

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