Silvis M J M, van den Heuvel F M A, van Garsse L, Nijveldt R
Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
Department of Cardiothoracic Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.
Eur Heart J Case Rep. 2023 Apr 10;7(4):ytad164. doi: 10.1093/ehjcr/ytad164. eCollection 2023 Apr.
endocarditis is a rare but fulminant disease.
A 74-year-old female with a history of asymptomatic severe aortic valve stenosis and permanent atrial fibrillation presented with acute onset of fever (39.0°C). Electrocardiogram showed diffuse ST-segment elevation. She was hospitalized for further analysis. All blood cultures were positive for and antibiotic treatment was started. Transthoracic echocardiography (TTE) showed known aortic valve stenosis without clear signs of endocarditis. The following day, a transoesophageal echocardiogram (TEE) showed a new moderate aortic valve regurgitation, new pericardial effusion (PE), and a thickened sinus of Valsalva (SOV) consistent with endocarditis with paravalvular involvement. Positron emission tomography-computed tomography was consistent with aortic valve endocarditis with paravalvular expansion. The patient was transferred to a tertiary referral centre for surgical treatment. On admission, patient was in shock and a second TTE revealed a new systolic and diastolic flow through the SOV to the right ventricle indicating SOV perforation. Additionally, there was flow in the PE suggestive of perforation of one of the cardiac chambers or large vessels. Emergent surgery showed extended infection with SOV perforation and a large perforation of the right ventricle. Ultimately, patient died during the operation because of extensive infection and refractory shock.
endocarditis is a severe disease with poor response to conventional anti-microbial treatment, destructive complications requiring surgery, and has a high mortality risk.
心内膜炎是一种罕见但凶险的疾病。
一名74岁女性，有无症状重度主动脉瓣狭窄和永久性心房颤动病史，出现急性发热（39.0°C）。心电图显示广泛ST段抬高。她因进一步检查入院。所有血培养均为阳性，遂开始抗生素治疗。经胸超声心动图（TTE）显示已知的主动脉瓣狭窄，无明确的心内膜炎迹象。次日，经食管超声心动图（TEE）显示新发中度主动脉瓣反流、新发心包积液（PE）以及增厚的主动脉瓣窦（SOV），符合伴有瓣周受累的心内膜炎。正电子发射断层扫描 - 计算机断层扫描与伴有瓣周扩展的主动脉瓣心内膜炎相符。患者被转至三级转诊中心接受手术治疗。入院时患者处于休克状态，第二次TTE显示有新的收缩期和舒张期血流从SOV进入右心室，提示SOV穿孔。此外，心包积液中有血流，提示心脏腔室或大血管之一穿孔。急诊手术显示感染扩展，伴有SOV穿孔和右心室大穿孔。最终，患者在手术期间因广泛感染和难治性休克死亡。
心内膜炎是一种严重疾病，对传统抗菌治疗反应不佳，有需要手术治疗的破坏性并发症，且死亡风险高。
