Jeng Eric I, Martin Tomas D
Division of Thoracic and Cardiovascular Surgery, College of Medicine, University of Florida, Gainesville, Florida.
J Card Surg. 2020 Jul;35(7):1714-1716. doi: 10.1111/jocs.14645. Epub 2020 Jun 19.
This study highlights the management strategy in simultaneous bicuspid aortic valve infective endocarditis and mycotic pseudoaneurysm of an aortic coarctation.
A staged repair of mycotic pseudoaneurysm of aortic coarctation and infective bicuspid aortic valve endocarditis.
We present a 19-year old gentleman who was admitted with aching pain in his bilateral lower extremities with associated purpuric rash and fevers. Work-up was significant for severe aortic valve regurgitation and a pseudoaneurysm in the distal aortic arch. He underwent operative repair through a left posterior-lateral thoracotomy with femoral-femoral partial cardiopulmonary bypass. Intraoperative findings were significant for a juxta-ductal coarctation and pseudoaneurysm. The mycotic pseudoaneurysm and remnant ligamentum arteriosum were completely resected and were replaced with a 18 mm Gelweave graft (Terumo Cardiovascular Group, Ann Arbor, MI) from the distal arch to the descending thoracic aorta. The patient underwent a planned secondary washout and omental flap for biologic coverage of the graft. Subsequently, a staged aortic valve replacement was completed 1 week later. The patient's postoperative course was uncomplicated, and he was discharged with intact motor and sensory function.
A staged approach is a prudent strategy to manage a patient with simultaneous endocarditis and aortic mycotic pseudoaneurysm, with precedence toward the most critical lesion.
本研究强调了同时患有二叶式主动脉瓣感染性心内膜炎和主动脉缩窄霉菌性假性动脉瘤的管理策略。
对主动脉缩窄霉菌性假性动脉瘤和感染性二叶式主动脉瓣心内膜炎进行分期修复。
我们报告一名19岁男性，因双侧下肢疼痛伴紫癜性皮疹和发热入院。检查发现严重主动脉瓣反流和主动脉弓远端假性动脉瘤。他通过左后外侧开胸术并采用股-股部分体外循环进行手术修复。术中发现显著的导管旁缩窄和假性动脉瘤。霉菌性假性动脉瘤和动脉导管韧带残余部分被完全切除，并用一段18毫米的Gelweave移植物（泰尔茂心血管集团，密歇根州安阿伯）从主动脉弓远端至胸降主动脉进行替换。患者接受了计划性的二次冲洗和网膜瓣移植以生物覆盖移植物。随后，1周后完成分期主动脉瓣置换。患者术后过程无并发症，出院时运动和感觉功能完好。
分期治疗方法是管理同时患有心内膜炎和主动脉霉菌性假性动脉瘤患者的谨慎策略，优先处理最关键的病变。
