Hisatomi Kazuki, Miyanaga Tatsuya, Miura Takashi, Eishi Kiyoyuki
Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
Department of Cardiovascular Surgery, Hakujyuji Hospital, Fukuoka, Japan.
Surg Case Rep. 2024 Jun 19;10(1):151. doi: 10.1186/s40792-024-01943-5.
Gerbode defect is an unusual abnormal communication between the left ventricle and the right atrium and is a serious complication of aortic infective endocarditis. Group B Streptococcus is an uncommon cause of infective endocarditis and has a markedly destructive effect on valvular tissue. Acute fistulation between the left ventricle and the right atrium associated with this form of infective endocarditis is a life-threatening, aggressive complication that often requires urgent surgical intervention. However, the identification of actual communication is often extremely difficult. Herein, we describe an unusual case of Gerbode defect resulting from Group B Streptococcus infective endocarditis and discuss the issues surrounding such a rare cardiac defect and such an infection.
A 60-year-old man with underlying uncontrolled diabetes mellitus underwent endoscopic retrograde biliary drainage for acute cholangitis. On the 10th postoperative day, the patient developed multiple acute cerebral embolisms. Transthoracic echocardiography demonstrated severe aortic regurgitation and a large mobile vegetation near the tricuspid annulus. No obvious fistula between the left ventricle and the right atrium could be demonstrated. The blood culture examination was positive for Group B Streptococcus. The patient was diagnosed with Group B Streptococcus infective endocarditis, and antibiotic therapy was initiated. Transesophageal echocardiogram performed after referral to our hospital confirmed detachment of the right coronary cusp of the aortic valve from the annulus and an abnormal cavity immediately below the right coronary cusp. Color Doppler imaging finally revealed systolic blood flows from the left ventricle into the right atrium through the cavity. Therefore, we diagnosed the patient with Gerbode defect resulting from Group B Streptococcus infective endocarditis. In addition to aortic valve replacement, defect closure and left ventricular outflow tract repair were successfully performed urgently for severely complicated and uncommon infective endocarditis. The patient was uneventfully discharged without any complications.
We reported successful surgical treatment of unusual active IE and Gerbode defect caused by GBS. Careful preoperative echocardiographic work-up is imperative for accurate early diagnosis and successful repair.
Gerbode缺损是左心室与右心房之间一种罕见的异常交通，是主动脉感染性心内膜炎的严重并发症。B组链球菌是感染性心内膜炎的少见病因，对瓣膜组织有显著的破坏作用。这种形式的感染性心内膜炎相关的左心室与右心房之间的急性瘘管形成是一种危及生命的侵袭性并发症，常需紧急手术干预。然而，确定实际的交通情况往往极其困难。在此，我们描述一例由B组链球菌感染性心内膜炎导致的Gerbode缺损的罕见病例，并讨论围绕这种罕见心脏缺损及此类感染的相关问题。
一名60岁患有未控制的基础糖尿病的男性因急性胆管炎接受了内镜逆行胆管引流术。术后第10天，患者发生多处急性脑栓塞。经胸超声心动图显示严重的主动脉瓣反流以及三尖瓣环附近一个大的活动赘生物。未发现左心室与右心房之间有明显的瘘管。血培养检查B组链球菌呈阳性。患者被诊断为B组链球菌感染性心内膜炎，并开始抗生素治疗。转诊至我院后进行的经食管超声心动图证实主动脉瓣右冠状动脉瓣叶与瓣环分离，且在右冠状动脉瓣叶下方有一个异常腔隙。彩色多普勒成像最终显示收缩期血流从左心室通过该腔隙流入右心房。因此，我们诊断该患者为B组链球菌感染性心内膜炎导致的Gerbode缺损。除了主动脉瓣置换外，针对严重复杂且罕见的感染性心内膜炎，还成功紧急进行了缺损闭合及左心室流出道修复。患者顺利出院，无任何并发症。
我们报告了由B组链球菌引起的罕见活动性感染性心内膜炎及Gerbode缺损的成功手术治疗。术前仔细的超声心动图检查对于准确的早期诊断及成功修复至关重要。
