Edlin Joy C, Metwalli Amr, Finney Simon J, Ambekar Shirish G
Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.
BMJ Case Rep. 2020 Feb 28;13(2):e233564. doi: 10.1136/bcr-2019-233564.
A 43-year-old man with Austrian syndrome, the triad of infective endocarditis (IE), pneumonia and meningitis caused by , underwent emergency aortic and mitral valve replacement and closure of an aortic root abscess. Postoperatively, he required mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and an intra-aortic balloon pump. Several days after surgery, new mitral and aortic paraprosthetic leaks (PPLs) developed. These were managed conservatively, initially, but eventually required percutaneous closure 6 weeks after the initial operation. This has enabled the patient to recover to independent mobility, 20 weeks after the operation. This case illustrates a rare clinical syndrome and the devastating impact of IE. Moreover, it illustrates the successful application of extracorporeal membrane oxygenation in postcardiotomy cardiac failure and the successful treatment of PPL in a patient unfit for redo surgery.
一名患有奥地利综合征（由感染性心内膜炎（IE）、肺炎和脑膜炎组成的三联征）的43岁男性，接受了紧急主动脉和二尖瓣置换以及主动脉根部脓肿闭合术。术后，他需要静脉-动脉体外膜肺氧合和主动脉内球囊泵进行机械循环支持。术后几天，新的二尖瓣和主动脉人工瓣膜旁漏（PPL）出现。最初对这些漏口进行了保守处理，但最终在初次手术后6周需要进行经皮闭合。这使得患者在手术后20周恢复到能够独立活动。该病例说明了一种罕见的临床综合征以及IE的破坏性影响。此外，它还说明了体外膜肺氧合在心脏手术后心力衰竭中的成功应用以及对不适于再次手术的患者PPL的成功治疗。
