Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan.
Department of Infectious Diseases, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan.
BMC Cardiovasc Disord. 2023 Mar 24;23(1):152. doi: 10.1186/s12872-023-03176-0.
The number of patients with heart disease who can benefit from treatment is continuing to increase due to the widespread use of cardiac implantable devices. Accordingly, the number of cardiac device-related infective endocarditis (CDRIE) cases has been increasing year by year. We report a very rare experience of performing an autopsy on a patient who died of CDRIE at the site of MitraClip ® implantation, which has recently been developed as a treatment option for severe mitral regurgitation. In addition to hematoxylin-eosin (H-E) staining, Elastica-Masson staining in the present case revealed destruction of all of the atrial, trabecular, fiber and myocardial layers.
The patient was hemodialyzed with a dialysis catheter. Hemodialysis treatment was difficult due to functional mitral regurgitation caused by cardiac dysfunction, and the MitraClip® procedure was performed. However, he subsequently developed a fever and dialyzation became difficult again, and he was admitted to the cardiology department. Echocardiography revealed a large vegetation at the site of MitraClip® implantation and a diagnosis of CDRIE was made. Guidelines recommend removal of the device and surgical intervention. However, considering the patient's general condition, a decision was made at a heart team conference to give priority to antibiotic therapy. However, the patient did not respond to antibiotic therapy and died of septic shock.
To our knowledge, this is the first reported case of CDRIE and death after MitraClip® implantation that resulted in an autopsy. Furthermore, not only H-E staining but also Elastica-Masson staining was performed, and it was confirmed that there was significant valve tissue destruction. In the future, the MitraClip® procedure, even though it is minimally invasive, should be carefully considered in immunocompromised patients.
由于心脏植入设备的广泛应用，越来越多的心脏病患者可以从中受益，因此，心脏器械相关感染性心内膜炎（CDRIE）的病例数量逐年增加。我们报告了一例非常罕见的病例，一名患者因经导管二尖瓣夹合术（MitraClip®）治疗重度二尖瓣反流而发生 CDRIE 死亡，我们对其进行了尸检。除了苏木精-伊红（H-E）染色外，本病例的弹力纤维-马松染色显示所有心房、小梁、纤维和心肌层均被破坏。
患者因心功能障碍导致功能性二尖瓣反流而行血液透析，且使用透析导管进行血液透析治疗。然而，此后他出现发热，透析再次出现困难，遂转入心内科。超声心动图显示在 MitraClip® 植入部位有一个大的赘生物，诊断为 CDRIE。指南建议取出器械并进行手术干预。然而，考虑到患者的一般情况，在心脏团队会议上决定优先进行抗生素治疗。然而，患者对抗生素治疗无反应，死于感染性休克。
据我们所知，这是首例报道的经导管二尖瓣夹合术（MitraClip®）治疗后发生 CDRIE 并导致死亡的尸检病例。此外，不仅进行了 H-E 染色，还进行了弹力纤维-马松染色，证实了有明显的瓣膜组织破坏。在未来，对于免疫功能低下的患者，即使经导管二尖瓣夹合术（MitraClip®）是一种微创治疗方法，也应慎重考虑。
