Shah Muhammad Azam, Alghamdi Abdulaziz Ali Ahmed, Alogabey Saif Hasan, Qattea Mohammad Bara, Bajwa Iftikhar Ahmed
FCPS, Cardiology, Saudi Board of Echocardiography, NBE (USA), King Fahad Medical City, Dabab Street, Sulaimaniya, PO Box 221124, Riyadh 11311, Saudi Arabia.
Saudi Board of Internal Medicine, Saudi Board of Cardiology, King Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh 11525, Kingdom of Saudi Arabia.
Eur Heart J Case Rep. 2018 Mar 14;2(1):yty031. doi: 10.1093/ehjcr/yty031. eCollection 2018 Mar.
Congenital heart defects predispose patients to a significantly increased risk of infective endocarditis (IE), and the incidence is even greater in the immunocompromised population. The involvement of multiple valves leads to a higher rate of complications and thus mortality. Moreover, biventricular IE is an uncommon condition with no specific guidelines for treatment.
In this report, we discuss a case of an immunocompetent young male with a congenital perimembranous ventricular septal defect, complicated by multivalvular and right ventricular free wall vegetations. Biventricular involvement of IE along with septic embolization to both the pulmonary and systemic circulation resulted in challenges in the management of this patient.
The decision regarding timing and type (surgical vs. conservative) of treatment in such a complicated and aggressive IE case should be based on individual circumstances. However, the strategy of initial antibiotic therapy followed by surgical intervention can be a suitable option in such patients.
先天性心脏病使患者感染性心内膜炎（IE）的风险显著增加，在免疫功能低下人群中发病率更高。多个瓣膜受累会导致更高的并发症发生率，进而增加死亡率。此外，双心室感染性心内膜炎是一种罕见疾病，没有特定的治疗指南。
在本报告中，我们讨论了一例免疫功能正常的年轻男性病例，该患者患有先天性膜周部室间隔缺损，并发多瓣膜及右心室游离壁赘生物。感染性心内膜炎累及双心室并伴有肺循环和体循环的脓毒性栓塞，给该患者的治疗带来了挑战。
在这种复杂且进展迅速的感染性心内膜炎病例中，关于治疗时机和类型（手术治疗与保守治疗）的决策应基于个体情况。然而，先进行初始抗生素治疗再进行手术干预的策略可能是这类患者的合适选择。
