Osaki Jun, Fumoto Hideyuki, Uchino Motonori, Nakayama Yoshihiro
Department of Cardiovascular Surgery, Oosumi Kanoya Hospital, Kanoya, Japan.
Kyobu Geka. 2021 Oct;74(11):950-953.
Isolated pulmonary valve infective endocarditis is rare and accounts for only 1.5% to 2.0% of all cases of infective endocarditis. We present a case of isolated pulmonary valve endocarditis, which was successfully treated by pulmonary valve replacement. A 69-year-old man presented with fever and was diagnosed with active pulmonary valve infective endocarditis. He had no apparent predisposing factors. Blood cultures were positive for Streptococcus viridans, and transesophageal echocardiography showed mobile vegetation. His condition improved transiently with intravenous antibiotic therapy;however, high fever and reduced oxygen saturation recurred. Computed tomography showed multiple infiltrative shadows suggesting septic pulmonary embolisms. Urgent surgery was indicated because antibiotic treatment was ineffective. During the operation, we found that vegetation had destroyed all pulmonary leaflets. We performed pulmonary valve replacement with a stented bioprosthetic valve as well as enlargement of the right ventricular outflow tract with a bovine pericardial patch. The postoperative course was uneventful. Antibiotic therapy was continued for six weeks after surgery. For two years since surgery, the patient has experienced no recurrence of infection.
孤立性肺动脉瓣感染性心内膜炎较为罕见，仅占所有感染性心内膜炎病例的1.5%至2.0%。我们报告一例孤立性肺动脉瓣心内膜炎病例，该病例通过肺动脉瓣置换术成功治愈。一名69岁男性因发热就诊，被诊断为活动性肺动脉瓣感染性心内膜炎。他没有明显的易感因素。血培养结果显示草绿色链球菌阳性，经食管超声心动图显示有活动的赘生物。静脉抗生素治疗后他的病情暂时好转；然而，高热和氧饱和度降低再次出现。计算机断层扫描显示多个浸润性阴影，提示脓毒性肺栓塞。由于抗生素治疗无效，故需紧急手术。手术过程中，我们发现赘生物已破坏了所有肺动脉瓣叶。我们用带支架的生物瓣膜进行了肺动脉瓣置换，并使用牛心包补片扩大了右心室流出道。术后过程顺利。术后继续抗生素治疗六周。术后两年以来，患者未出现感染复发。
