Toader Despina, Cocora Mioara, Bătăiosu Constantin, Ocroteală Luminiă
Department of Cardiology, Craiova Cardiology Center, EuroEchoLab, Str Tabaci nr1, Craiova, Romania.
Cardiovascular Surgery Department, Institute of Cardiovascular Disease, Timișoara, Romania.
Eur Heart J Case Rep. 2020 Dec 15;5(1):ytaa452. doi: 10.1093/ehjcr/ytaa452. eCollection 2021 Jan.
Bicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1-2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality.
We report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up.
This is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The 'take away' message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.
二叶式主动脉瓣是最常见的先天性心血管畸形，在人群中的发生率为1%-2%。血流动力学改变出现较早，导致组织损伤并易发生细菌黏附。瓣周扩展的发生在二叶式主动脉瓣心内膜炎中很常见。厌氧菌感染性心内膜炎是一种罕见疾病，死亡率很高。
我们报告一例年轻女性二叶式主动脉瓣感染性心内膜炎病例。感染细菌为厌氧链球菌，疾病临床过程极具侵袭性。超声心动图评估显示主动脉瓣和二尖瓣反流、瓣周脓肿、室间隔缺损和心包积液。手术方式包括在彻底切除主动脉根部脓肿并重建瓣环后用机械瓣膜置换主动脉瓣。室间隔缺损也用心包补片封闭。术后第一天开始抗凝治疗。患者在手术干预前接受了10天抗生素治疗，术后接受了4周抗生素治疗。在1个月和6个月随访时恢复情况良好。
这是一例严重的心内膜炎病例，并发广泛的瓣膜破坏、主动脉根部脓肿和瘘管。瓣周并发症在二叶式主动脉瓣心内膜炎患者中很常见。关键信息是超声心动图是感染性心内膜炎患者诊断、管理和随访的重要工具。
