Cardiology, Scripps Health, San Diego, California, USA
Cardiology, Scripps Health, San Diego, California, USA.
BMJ Case Rep. 2022 May 2;15(5):e248951. doi: 10.1136/bcr-2022-248951.
An 88-year-old man with small lymphocytic lymphoma presented to the hospital with shortness of breath and was diagnosed with heart failure. Serial blood cultures and echocardiography revealed endocarditis, complicated by severe aortic regurgitation. Despite intravenous antibiotic therapy and aggressive intravenous diuresis therapy in the hospital, he decompensated into cardiogenic shock, requiring invasive haemodynamic monitoring and inotrope therapy. With multidisciplinary discussion involving the patient and his children, there was a joint decision that at his advanced age, he would not pursue surgical aortic valve replacement and instead proceed with a transcatheter aortic valve replacement (TAVR) with palliative intent. He underwent TAVR with subsequent symptomatic and functional improvement as well as resolution of cardiogenic shock.
一位 88 岁患有小淋巴细胞淋巴瘤的男性因呼吸急促到医院就诊，被诊断为心力衰竭。连续的血培养和超声心动图显示患有心内膜炎，并发严重的主动脉瓣反流。尽管在医院接受了静脉内抗生素治疗和积极的静脉内利尿剂治疗，但他还是出现心源性休克失代偿，需要进行有创血流动力学监测和正性肌力药物治疗。经过多学科讨论，包括与患者及其子女的讨论，大家共同决定，鉴于他年事已高，不会进行主动脉瓣置换手术，而是采用姑息性经导管主动脉瓣置换术（TAVR）。他接受了 TAVR 治疗，随后症状和功能均得到改善，心源性休克也得到了缓解。
