Javaid Awad, Sehgal Sumit, Dazley Jason
Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 West Charleston Blvd, Suite 230, Las Vegas, NV 89102, USA.
Department of Cardiology, University of Nevada Las Vegas School of Medicine, 1701 West Charleston Blvd, Suite 230, Las Vegas, NV 89102, USA.
Eur Heart J Case Rep. 2019 Oct 22;3(4):1-4. doi: 10.1093/ehjcr/ytz185. eCollection 2019 Dec.
Here, we outline the case of a US Veteran's Health Administration (VA) patient with a history of recent bioprosthetic aortic valve replacement (AVR) and recent intravenous drug use (IVDU) who was found to have three-valve infective endocarditis (IE) resulting in septic shock. We highlight this case because it represents an uncommon case of three-valve IE in the setting of recent bioprosthetic valve replacement and IVDU, and it raises the need for continued awareness of mental health and drug rehabilitation in the US military veteran population.
A 62-year-old gentleman with recent bioprosthetic AVR presented with dyspnoea and lower extremity oedema and was found to have a heart failure exacerbation. He developed sepsis and was found to have three-valve endocarditis, as well as aortic root abscess and pacemaker lead infection. He was treated with broad-spectrum antibiotics and evaluated for surgical intervention. After discussion with the surgical team, the patient decided not to pursue surgery due to prohibitively high perioperative mortality risk. The patient was transferred to hospice and expired within 2 weeks.
Three-valve IE is sparingly documented in published literature and can be difficult to treat. Providers must be cognizant of prosthetic valve endocarditis as an uncommon but known complication of valve replacement surgery. Intravenous drug use is a common risk factor for endocarditis and is prevalent in the US military veteran population. Prosthetic valve endocarditis should be treated with broad-spectrum antibiotics, and in general, if it leads to new significant valvular abnormalities, the valve should be replaced.
在此，我们概述了一名美国退伍军人健康管理局（VA）患者的病例，该患者近期接受了生物人工主动脉瓣置换术（AVR），且近期有静脉注射吸毒史（IVDU），被发现患有三尖瓣感染性心内膜炎（IE）并导致感染性休克。我们强调此病例，因为它代表了近期生物人工瓣膜置换和IVDU情况下罕见的三尖瓣IE病例，并且它凸显了在美国退伍军人人群中持续关注心理健康和药物康复的必要性。
一名近期接受生物人工AVR的62岁男性因呼吸困难和下肢水肿就诊，被发现心力衰竭加重。他发展为脓毒症，被发现患有三尖瓣心内膜炎，以及主动脉根部脓肿和起搏器导线感染。他接受了广谱抗生素治疗，并接受了手术干预评估。在与手术团队讨论后，由于围手术期死亡风险过高，患者决定不进行手术。患者被转至临终关怀机构，并在2周内死亡。
三尖瓣IE在已发表的文献中记载较少，且可能难以治疗。医疗服务提供者必须认识到人工瓣膜心内膜炎是瓣膜置换手术一种罕见但已知的并发症。静脉注射吸毒是心内膜炎常见的危险因素，在美国退伍军人人群中很普遍。人工瓣膜心内膜炎应用广谱抗生素治疗，一般来说，如果导致新的严重瓣膜异常，应更换瓣膜。
