Aljassim Nada A, Almashraki Nabeel, Tageldein Mohamed, Tamimi Omer, Kabbani Mohamed S, Zahraa Jihad, Alshehri Mohammed
Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2020;77:71-75. doi: 10.1016/j.ijscr.2020.10.085. Epub 2020 Oct 29.
Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines.
We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit.
Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes.
Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.
与健康儿童相比，感染性心内膜炎在先天性心脏病儿童中更为普遍。社区获得性耐甲氧西林金黄色葡萄球菌是感染性心内膜炎的致病病原体，在健康儿童中很少引起全心炎。尽管有管理指南，但对于左侧心脏赘生物的手术干预临床决策仍具有挑战性。
我们报告一例先前健康的12岁女孩，她因社区获得性耐甲氧西林金黄色葡萄球菌感染继发侵袭性心内膜炎，伴有左侧赘生物、二尖瓣反流、全心炎、脑脓肿和中风。她接受了紧急赘生物切除术和二尖瓣修复术。首次手术后三周，她出现左心室假性动脉瘤，需要进行挽救生命的手术干预。患儿逐渐康复，出院时心脏功能可接受，有轻度神经功能缺损。
全心炎，尤其是进展迅速导致心内假性动脉瘤的情况，在健康儿童中很少见。小儿感染性心内膜炎管理中手术干预的最佳时机尚无明确定义，临床决策过程仍然具有挑战性。左心室假性动脉瘤的发生很严重，鉴于其破裂风险高及随后的灾难性后果，也需要立即干预。
社区获得性耐甲氧西林金黄色葡萄球菌是健康儿童侵袭性感染性全心炎的病因，可导致心内假性动脉瘤。对于有左侧赘生物的儿童应考虑紧急手术干预，以防止出现灾难性后果。
