Patel Mitra, Grotton Connor, Ravi Sreeram, Benson Sarah, Soni Ronak G
Medicine, University of Toledo College of Medicine, Toledo, USA.
Cardiovascular Medicine, University of Toledo College of Medicine, Toledo, USA.
Cureus. 2020 Dec 18;12(12):e12159. doi: 10.7759/cureus.12159.
Minor conduction abnormalities such as first-degree heart blocks are generally overlooked on electrocardiogram (EKG) as their impact on clinical management is usually not substantial. However, they can be an important screening tool for early diagnosis of infective endocarditis (IE) and associated perivalvular complications, especially in patients with surgical valve replacements. This case report describes a 58-year-old male with a past medical history of bicuspid aortic valve status post replacement five years prior to presentation who initially presented with presumed symptoms of a complicated urinary tract infection (UTI) and later developed chest pain and shortness of breath. He showed no initial signs of infection including negative blood and urine cultures. EKG showed new onset prolonged PR interval. He then underwent a transthoracic echocardiogram (TTE) which showed prosthetic valve dysfunction and subsequently underwent transesophageal echocardiogram (TEE) which revealed vegetations on all leaflets and circumferential peri-aortic abscess encompassing both coronary ostia and extending towards the tricuspid and mitral valve leaflets. The patient then underwent redo-sternotomy for dissection of mediastinal adhesions, extraction of the aortic bio-prosthesis, and debridement of the aortic root abscess. The aortic root was replaced with a homograft and the valve cultures were positive for . The patient developed complete heart block afterwards and received a permanent pacemaker; repeat cultures showed no further evidence of infection. This case report is presented to reiterate the importance of early detection of IE-related aortic valve abscess and their rare sequelae. Early screening for conduction abnormalities via EKG and subsequently a TEE can allow prompt identification and management of valvular abnormalities to prevent life-threatening complications and improve patient outcomes.
轻度传导异常，如一度心脏传导阻滞，在心电图（EKG）上通常被忽视，因为它们对临床管理的影响通常不大。然而，它们可能是早期诊断感染性心内膜炎（IE）及相关瓣周并发症的重要筛查工具，尤其是在接受人工瓣膜置换术的患者中。本病例报告描述了一名58岁男性，有二叶式主动脉瓣病史，在就诊前五年接受了置换手术，最初表现为疑似复杂性尿路感染（UTI）的症状，后来出现胸痛和呼吸急促。他最初没有感染迹象，包括血培养和尿培养均为阴性。心电图显示新出现的PR间期延长。随后他接受了经胸超声心动图（TTE）检查，结果显示人工瓣膜功能障碍，随后又接受了经食管超声心动图（TEE）检查，发现所有瓣叶上均有赘生物，以及环绕主动脉的脓肿，累及两个冠状动脉开口，并延伸至三尖瓣和二尖瓣瓣叶。该患者随后接受了再次胸骨切开术，以分离纵隔粘连、取出主动脉生物假体并清除主动脉根部脓肿。主动脉根部用同种异体移植物置换，瓣膜培养结果显示……呈阳性。患者随后出现完全性心脏传导阻滞，并接受了永久性起搏器植入；重复培养未发现进一步感染迹象。本病例报告旨在重申早期发现IE相关主动脉瓣脓肿及其罕见后遗症的重要性。通过心电图及随后的经食管超声心动图进行早期传导异常筛查，可及时识别和处理瓣膜异常，以预防危及生命的并发症并改善患者预后。
