Radcliffe Christopher, Oen-Hsiao Joyce, Grant Matthew
Yale School of Medicine, New Haven, CT 06510, USA.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA.
Pathogens. 2020 Nov 29;9(12):998. doi: 10.3390/pathogens9120998.
Infective endocarditis classically involves non-sterile vegetations on valvular surfaces in the heart. Feared complications include embolization and acute heart failure. Surgical intervention achieves source control and alleviates valvular regurgitation in complicated cases. Vegetations >1 cm are often intervened upon, making massive vegetations uncommon in modern practice. We report the case of a 39-year-old female with history of intravenous drug abuse who presented with a serpiginous vegetation on the native tricuspid valve and methicillin-resistant bacteremia. The vegetation grew to 5.6 cm by hospital day two, and she successfully underwent a tricuspid valvectomy. Six weeks of intravenous vancomycin therapy were completed without adverse events. To better characterize other dramatic presentations of infective endocarditis, we performed a systematic literature review and summarized all case reports involving ≥4 cm vegetations.
感染性心内膜炎典型地累及心脏瓣膜表面的非无菌性赘生物。令人担忧的并发症包括栓塞和急性心力衰竭。在复杂病例中，手术干预可实现源头控制并减轻瓣膜反流。直径大于1厘米的赘生物常需进行干预，使得巨大赘生物在现代医疗实践中并不常见。我们报告一例39岁有静脉药物滥用史的女性病例，其原发性三尖瓣上出现匐行性赘生物并伴有耐甲氧西林菌血症。到住院第二天时，赘生物长到了5.6厘米，她成功接受了三尖瓣切除术。完成了六周的静脉万古霉素治疗，未出现不良事件。为了更好地描述感染性心内膜炎的其他显著表现，我们进行了系统的文献综述，并总结了所有涉及直径≥4厘米赘生物的病例报告。
