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经导管主动脉瓣植入术后人工瓣膜感染性心内膜炎的成功外科主动脉瓣置换术。

Successful surgical aortic valve replacement for prosthetic valve infective endocarditis following transcatheter aortic valve implantation.

作者信息

Takimoto Shinya, Minakata Kenji, Yamazaki Kazuhiro, Hirao Shingo, Watanabe Kentaro, Saito Naritatsu, Imai Masao, Watanabe Shin, Watanabe Hirotoshi, Daijo Hiroki, Kimura Takeshi, Sakata Ryuzo

机构信息

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

出版信息

J Cardiol Cases. 2015 Apr 25;12(1):20-22. doi: 10.1016/j.jccase.2015.03.012. eCollection 2015 Jul.

Abstract

An 80-year-old male underwent a transcatheter aortic valve implantation (TAVI) for severe senile aortic stenosis. Six weeks after the surgery, he was readmitted to our institution because of a high-grade fever. Transesophageal echocardiography revealed thickening of all three leaflets of the aortic prosthesis and mobile mass on the leaflet, and was identified from his blood culture. Therefore, he was diagnosed with prosthetic valve endocarditis (PVE) and received intensive intravenous antibiotic therapy. Because he did not respond to the pharmacological therapy, surgical aortic valve replacement (AVR) was indicated although it was considered a relatively high-risk procedure. Herein, we report on the successful surgical AVR in this patient using a pericardial valve after removal of the infected prosthetic valve, and discuss some issues related to this rare complication after TAVI. < Transcatheter aortic valve implantation (TAVI) is a highly effective procedure for patients with symptomatic severe aortic stenosis who are at high risk or deemed inoperable. Because it only requires limited surgical invasiveness, the risk of prosthetic valve endocarditis (PVE) after TAVI is thought to be low. However, PVE can occur even early after TAVI. We present our recent such case and discuss some issues related to this rare complication.>.

摘要

一名80岁男性因严重老年主动脉瓣狭窄接受了经导管主动脉瓣植入术(TAVI)。术后六周,他因高热再次入院。经食管超声心动图显示主动脉人工瓣膜的三个瓣叶均增厚,且瓣叶上有活动团块,血培养发现了[病原体名称未给出]。因此,他被诊断为人工瓣膜心内膜炎(PVE),并接受了强化静脉抗生素治疗。由于他对药物治疗无反应,尽管手术主动脉瓣置换术(AVR)被认为是一项风险相对较高的手术,但仍被列为治疗方案。在此,我们报告该患者在移除感染的人工瓣膜后使用心包瓣膜成功进行手术AVR的病例,并讨论TAVI后这种罕见并发症的相关问题。<经导管主动脉瓣植入术(TAVI)对于有症状的严重主动脉瓣狭窄且手术风险高或被认为无法手术的患者是一种非常有效的手术。由于它仅需要有限的手术侵入性,TAVI后人工瓣膜心内膜炎(PVE)的风险被认为较低。然而,PVE甚至可能在TAVI后早期发生。我们展示我们最近遇到的此类病例,并讨论与这种罕见并发症相关的一些问题。>

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