Vila-Olives Rosa, Oristrell Gerard, Rello Pau, Fernández-Hidalgo Núria
Cardiology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER CV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
Eur Heart J Case Rep. 2023 Apr 12;7(4):ytad166. doi: 10.1093/ehjcr/ytad166. eCollection 2023 Apr.
Infective endocarditis is a life-threatening disease associated with high mortality. Appropriate antimicrobial treatment and cardiac surgery, when indicated, are closely related to prognosis. When cardiac surgery is contraindicated, prognosis worsens dramatically. There is few data concerning the use of transcatheter aortic valve replacement after healed aortic valve endocarditis or during active IE. We present the first case report of a transcatheter aortic valve replacement implanted during antimicrobial therapy for a severely symptomatic acute aortic regurgitation due to an infective endocarditis complicated with a perivalvular abscess.
A 68-year-old man was admitted due to left hemiparesis and fever. An acute ischaemic stroke with haemorrhagic transformation was diagnosed. Blood cultures were positive for methicillin-susceptible and a transoesophageal echocardiogram revealed an aortic endocarditis with an acute severe aortic regurgitation and a perivalvular abscess. Urgent cardiac surgery was contraindicated due to intracranial haemorrhage. However, the patient developed refractory pulmonary oedema and haemodynamic instability. Despite the perivalvular abscess, a transcatheter aortic valve replacement was successfully performed 15 days after the diagnosis. Nine months after completing antimicrobial therapy, there were no signs of relapse.
Transcatheter aortic valve replacement could be considered in selected patients with symptomatic severe aortic regurgitation due to aortic infective endocarditis during antimicrobial therapy when cardiac surgery is contraindicated.
感染性心内膜炎是一种危及生命的疾病，死亡率很高。适当的抗菌治疗和必要时的心脏手术与预后密切相关。当心脏手术禁忌时，预后会急剧恶化。关于感染性心内膜炎治愈后或活动性感染性心内膜炎期间使用经导管主动脉瓣置换术的数据很少。我们报告了首例在抗菌治疗期间因感染性心内膜炎合并瓣周脓肿导致严重症状性急性主动脉反流而植入经导管主动脉瓣置换术的病例。
一名68岁男性因左侧偏瘫和发热入院。诊断为急性缺血性脑卒中伴出血转化。血培养对甲氧西林敏感菌呈阳性，经食管超声心动图显示主动脉心内膜炎伴急性严重主动脉反流和瓣周脓肿。由于颅内出血，紧急心脏手术禁忌。然而，患者出现难治性肺水肿和血流动力学不稳定。尽管存在瓣周脓肿，仍在诊断后15天成功进行了经导管主动脉瓣置换术。完成抗菌治疗9个月后，无复发迹象。
对于因主动脉感染性心内膜炎导致有症状的严重主动脉反流且在抗菌治疗期间心脏手术禁忌的特定患者，可考虑行经导管主动脉瓣置换术。
