Sunnaa Michael, Dhawan Ritika, Tabachnick Deborah, Attanasio Steve
Internal Medicine, Rush University Medical Center, Chicago, USA.
Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, USA.
Cureus. 2023 Feb 17;15(2):e35101. doi: 10.7759/cureus.35101. eCollection 2023 Feb.
A 51-year-old male with a past medical history of bicuspid aortic valve, hypertension, and anterior cerebral artery stroke of unclear etiology three months earlier, presented to the Emergency Department with progressive shortness of breath, hemoptysis, and night sweats. The patient's echocardiogram revealed a mobile mass greater than 1.0 cm in diameter on the bicuspid aortic valve, which was not present on the echocardiogram three months prior, during his stroke workup. Per modified Duke's criteria, this patient was found to have 'definite' infective endocarditis despite persistently negative blood cultures. The patient underwent urgent surgical aortic valve replacement and a ventricular septal defect was noted that was not seen on prior imaging. The patient was discharged on intravenous antibiotics and warfarin. The patient was able to return to his normal functional status weeks after surgery, and is continuing to exercise without limitation. This case provides an example of patients with bicuspid aortic valves having an increased propensity for developing infective endocarditis. While also highlighting the interesting intra-operative images and presentation of acute culture-negative endocarditis with vegetation, and the subsequent repair, treatment, and recovery.
一名51岁男性，有二叶式主动脉瓣病史、高血压病史，三个月前病因不明的大脑前动脉中风，因进行性气短、咯血和盗汗就诊于急诊科。患者的超声心动图显示二叶式主动脉瓣上有一个直径大于1.0厘米的活动团块，三个月前其进行中风检查时的超声心动图上并未出现该团块。根据改良的杜克标准，尽管血培养持续阴性，该患者仍被诊断为“确诊”感染性心内膜炎。患者接受了紧急主动脉瓣置换手术，术中发现了一个室间隔缺损，之前的影像学检查未发现该缺损。患者出院时接受静脉抗生素和华法林治疗。术后数周患者恢复到正常功能状态，目前继续无限制地进行锻炼。该病例举例说明了二叶式主动脉瓣患者发生感染性心内膜炎的倾向增加。同时突出了术中有趣的图像以及急性血培养阴性心内膜炎伴赘生物的表现，以及随后的修复、治疗和恢复情况。
