Wahbah Makhoul Gennifer, Mustafa Ahmad, Ling Joanne, Asogwa Nnedindu, Elhosseiny Sherif, Siddiqui Fasih Sami, Khan Shahkar, Lafferty James C, Glaser Allison
Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA.
Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA.
IDCases. 2023 Feb 13;31:e01710. doi: 10.1016/j.idcr.2023.e01710. eCollection 2023.
Endocarditis is more common in patients with cardiac prostheses. A Bentall procedure entails surgical replacement of the aortic valve, aortic root, and ascending aorta with re-implantation of coronary arteries into the graft.
65-year-old male with history of atrial fibrillation on rivaroxaban, bicuspid aortic valve, and ascending aortic aneurysm with a history of a Bentall procedure two years prior, presented with headache and dysarthria for one day. National Institutes of Health Stroke Scale was 3 and CT head showed 2.7 cm left frontal hematoma with extension into the subarachnoid space. Andexanet alfa was given for rivaroxaban reversal followed by cerebral angiogram which showed 5 mm intracranial inferior MCA aneurysm and embolization and coil placement was done. Blood cultures grew and transesophageal echocardiogram revealed aortic valve thickening and vegetation on the non-coronary cusp. He was subsequently treated with six weeks of IV ceftriaxone and Gentamycin.
With increasing use of bioprosthetic valves, the possibility of infective endocarditis with uncommon pathogens should be kept in mind. Lactococcus commonly affects native valves, however it can affect bioprosthetic valves and can present with mycotic aneurysms.
心内膜炎在心脏人工瓣膜患者中更为常见。Bentall手术需要外科手术置换主动脉瓣、主动脉根部和升主动脉，并将冠状动脉重新植入移植物中。
一名65岁男性，有房颤病史，正在服用利伐沙班，患有二叶式主动脉瓣和升主动脉瘤，两年前接受过Bentall手术，因头痛和构音障碍就诊一天。美国国立卫生研究院卒中量表评分为3分，头部CT显示左额叶有2.7厘米血肿并延伸至蛛网膜下腔。给予安多凝血酶α逆转利伐沙班的作用，随后进行脑血管造影，显示颅内大脑中动脉下动脉瘤为5毫米，并进行了栓塞和线圈置入。血培养生长出……，经食管超声心动图显示主动脉瓣增厚，无冠状动脉瓣叶有赘生物。随后他接受了六周的静脉注射头孢曲松和庆大霉素治疗。
随着生物瓣膜使用的增加，应牢记感染性心内膜炎由不常见病原体引起的可能性。乳酸球菌通常影响天然瓣膜，但也可影响生物瓣膜，并可表现为真菌性动脉瘤。
