Qureshi Imran A, Ashraf Sarah, Pervez Mohammad, Fatimi Saulat
Cardiothoracic Surgery, Aga Khan University, Karachi, PAK.
Surgery, University of Toronto, Toronto, CAN.
Cureus. 2022 Mar 14;14(3):e23147. doi: 10.7759/cureus.23147. eCollection 2022 Mar.
A 38-year-old female with no known comorbidities or previous history of heart disease presented to the hospital with a three-day history of drowsiness and shortness of breath. Transthoracic echocardiography was performed, which showed large vegetations on aortic and tricuspid valves. In addition, there was severe aortic regurgitation with a possible abscess on the non-coronary cusp of the aortic valve. The patient was admitted, and a provisional diagnosis of disseminated tuberculosis, Infective endocarditis (IE), and sepsis was made. Surgical intervention was planned. Intraoperative findings revealed that a fistula had formed connecting the aorta and right atrium, which was closed with an autologous graft derived from the patient's pericardial tissue. Vegetations were removed, and the aortic valve was replaced with a metallic valve. This case report presents a patient with complicated IE with a ruptured aortic root abscess. Mechanical complications associated with IE, such as in our case, are rare among patients with IE. However, surgical intervention should be considered as an option in complicated cases of IE when standard therapy fails.
一名38岁女性，无已知合并症及既往心脏病史，因嗜睡和气短3天入院。行经胸超声心动图检查，显示主动脉瓣和三尖瓣上有大量赘生物。此外，存在严重主动脉瓣反流，主动脉瓣无冠瓣可能有脓肿形成。患者入院后，初步诊断为播散性肺结核、感染性心内膜炎（IE）和脓毒症，并计划进行手术干预。术中发现形成了连接主动脉和右心房的瘘管，用取自患者心包组织的自体移植物将其封闭。清除赘生物，并用金属瓣膜置换主动脉瓣。本病例报告介绍了一名患有主动脉根部脓肿破裂的复杂性IE患者。与IE相关的机械性并发症，如我们病例中的情况，在IE患者中很少见。然而，当标准治疗失败时，对于复杂性IE病例应考虑手术干预作为一种选择。
