Mandal Amit K, Heer Randeep S, Petrou Mario, Missouris Constantinos G
Cardiology/Internal Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, GBR.
Cardiac Surgery, The Royal Brompton and Harefield NHS Foundation Trust, London, GBR.
Cureus. 2023 Mar 17;15(3):e36275. doi: 10.7759/cureus.36275. eCollection 2023 Mar.
In 2015, a 37-year-old man was referred for evaluation of hypertension and was found to have a mobile structure on the posterior mitral valve leaflet on echocardiography. Laboratory investigations yielded a diagnosis of primary antiphospholipid antibody syndrome (APLS). He underwent excision of the lesion and mitral valve repair. Histology confirmed the diagnosis of nonbacterial thrombotic endocarditis (NBTE). The patient was anticoagulated with warfarin up until 2018, which was substituted for rivaroxaban because of an erratic international normalised ratio. Serial echocardiography up to 2020 was unremarkable. In 2021, he presented with breathlessness and peripheral oedema. Echocardiography demonstrated large vegetation on both mitral valve leaflets. At the operation, vegetations were also evident on the left and noncoronary cusps of the aortic valve and he underwent mechanical aortic and mitral valve replacement. Histology confirmed NBTE. The case is unusual and highlights recurrent NBTE requiring re-do valve surgery.
2015年，一名37岁男性因高血压前来接受评估，超声心动图检查发现其二尖瓣后叶有一个可移动结构。实验室检查确诊为原发性抗磷脂抗体综合征（APLS）。他接受了病变切除及二尖瓣修复手术。组织学检查证实为非细菌性血栓性心内膜炎（NBTE）。该患者一直使用华法林抗凝至2018年，由于国际标准化比值不稳定，改用利伐沙班。直至2020年的系列超声心动图检查均无异常。2021年，他出现呼吸困难和外周水肿。超声心动图显示二尖瓣叶上有大量赘生物。手术时，主动脉瓣左瓣叶和无冠瓣叶上也可见赘生物，他接受了机械主动脉瓣和二尖瓣置换术。组织学检查证实为NBTE。该病例较为罕见，突出了复发性NBTE需要再次进行瓣膜手术的情况。
