Department Of Cardiology.
Department of Ultrasound, China-Japan Union Hospital of JiLin University, Changchun, Jilin, China.
Medicine (Baltimore). 2021 Feb 19;100(7):e24788. doi: 10.1097/MD.0000000000024788.
In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta.
The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment.
According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis.
At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection.
After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy.
The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.
近几十年来，由于早期识别和应用有效抗生素，梅毒的发病率有所下降。晚期梅毒常累及心血管系统，表现为单纯性主动脉炎、主动脉瓣关闭不全、冠状动脉狭窄或阻塞、主动脉瘤和黏液性心肌炎。在大多数关于该主题的病例报告中，梅毒引起的急性心肌梗死被认为是由于主动脉瓣关闭不全和冠状动脉狭窄，这是由于主动脉受累所致。
患者为 48 岁女性，因间歇性上腹痛伴胸闷 3 小时入院。患者曾有梅毒感染史，4 年前因子宫肌瘤住院，未进行相关治疗。
根据冠状动脉造影特点和实验室检查及超声心动图结果，最终诊断为梅毒相关性心肌梗死。
在首次诊断为梅毒时，患者未接受抗生素治疗。在诊断为心肌梗死后，患者接受了体外膜肺氧合（ECMO）技术辅助的经皮冠状动脉介入治疗（PCI）手术，成功在右冠状动脉开口和左主干开口处植入药物洗脱支架。然后，患者接受了青霉素治疗梅毒感染。
冠状动脉血运重建后，患者的心功能逐渐改善，联合优化药物治疗后左心室射血分数逐渐提高。
晚期梅毒常累及心血管系统，可导致严重并发症，如心肌梗死。一旦诊断出梅毒，就应给予标准治疗。对于冠状动脉开口狭窄，ECMO 技术辅助的 PCI 不仅保证了治疗的有效性，还降低了患者的手术风险。该病例表明 ECMO 辅助 PCI 的有效性，可为今后的患者治疗提供参考。
