West Virginia University School of Medicine, Morgantown, West Virginia.
Department of Internal Medicine, West Virginia University, Morgantown, West Virginia.
J Emerg Med. 2020 Jun;58(6):942-946. doi: 10.1016/j.jemermed.2020.02.016. Epub 2020 Apr 1.
Management of mitral valve regurgitation in patients with multiple comorbidities is complicated because of poor surgical candidacy. Less invasive techniques for these patients include the MitraClip device, an endovascular repair option used to reduce mitral valve regurgitation symptoms. However, complications include leaflet damage, stenosis, and infectious endocarditis.
Four years after MitraClip placement, an 80-year-old man presented to the emergency department with progressive dyspnea. He was diagnosed with MitraClip-associated infectious endocarditis by the emergency physician using point-of-care ultrasound. There are 6 reported cases of infective endocarditis in patients with MitraClip devices, with this being the first case identified using point-of-care ultrasound. This is also the first reported case of MitraClip-associated Corynebacterium endocarditis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The use of the MitraClip device and its echocardiographic appearance is not widely described in the published emergency medicine literature. Knowledge of this device, its appearance, and the potential complications is essential for emergency physicians caring for these patients. Rapid diagnosis may lead to earlier initiation of treatment and optimal disposition for these complex patients.
由于手术适应证较差，合并多种疾病的二尖瓣反流患者的治疗较为复杂。对于这些患者，微创技术包括经导管二尖瓣夹合装置，这是一种用于减轻二尖瓣反流症状的血管内修复选择。然而，并发症包括瓣叶损伤、狭窄和感染性心内膜炎。
在接受 MitraClip 装置治疗 4 年后，一名 80 岁男性因进行性呼吸困难到急诊科就诊。急诊医生通过即时护理超声检查诊断为与 MitraClip 相关的感染性心内膜炎。已有 6 例 MitraClip 装置相关感染性心内膜炎的病例报告，这是首次通过即时护理超声检查确诊的病例。这也是首例与 MitraClip 相关的棒状杆菌心内膜炎的报告。
为什么急诊医生应该了解这一点？：MitraClip 装置的使用及其超声心动图表现尚未在已发表的急诊医学文献中广泛描述。了解该装置、其外观和潜在并发症对于治疗这些患者的急诊医生至关重要。快速诊断可能导致更早开始治疗，并为这些复杂患者提供最佳处置。
