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左心室假性动脉瘤是二尖瓣心内膜炎手术修复罕见的灾难性并发症。

Left ventricular pseudoaneurysm as a rare catastrophic complication to surgical repair of mitral valve endocarditis.

作者信息

Khattab Mohammad Nasser, Tanous Adeeb, ALrefai Anas, Soleman Ragheb

机构信息

Department of Cardiology, Al Bassel Heart Institute, Damascus, Syria.

Department of Cardiac Surgery, Al Bassel Heart institute, Damascus, Syria.

出版信息

Int J Surg Case Rep. 2024 Oct;123:110213. doi: 10.1016/j.ijscr.2024.110213. Epub 2024 Aug 28.

Abstract

INTRODUCTION

Left ventricular pseudoaneurysm (LVPA) is rarely described in the medical literature, as a complication of mitral valve repair after infective endocarditis (IE) and only a few cases have been published until now.

CASE PRESENTATION

We reported a case of a woman in her forties without past medical history who underwent a successful surgical repair of mycotic pseudoaneurysm at the apex of the left ventricular after two months of mitral mechanical prosthetic valve replacement due to infective endocarditis.

DISCUSSION

Infective endocarditis (IE) remains a rare condition with high associated morbidity and mortality. The rapid and accurate diagnosis with optimal medical therapy in cases of suspected IE is a central challenge of the disease. Delayed diagnosis and initiation of treatment lead to complications and worse clinical outcomes. Fatal cardiac structural complications occur when the infection spreads to the heart and the infection tends to spread through the weakest annular structures, leading to the formation of a paravalvular abscess, fistula, and pseudoaneurysm.

CONCLUSION

The danger in this condition lies in causing a sudden hemodynamic collapse, which is difficult to treat without emergent surgical intervention. Result in a catastrophic condition and consequences. Therefore, early and rapid diagnosis remains the cornerstone of management.

摘要

引言

左心室假性动脉瘤(LVPA)在医学文献中鲜有描述,作为感染性心内膜炎(IE)后二尖瓣修复的一种并发症,迄今为止仅有少数病例发表。

病例报告

我们报告了一例四十多岁无既往病史的女性病例,该女性因感染性心内膜炎在二尖瓣机械瓣膜置换术后两个月,成功接受了左心室心尖部霉菌性假性动脉瘤的手术修复。

讨论

感染性心内膜炎(IE)仍然是一种罕见疾病,具有较高的相关发病率和死亡率。对疑似IE病例进行快速准确的诊断并给予最佳药物治疗是该疾病的核心挑战。诊断和治疗延迟会导致并发症和更差的临床结局。当感染扩散至心脏时会发生致命的心脏结构并发症,且感染往往通过最薄弱的瓣环结构扩散,导致瓣周脓肿、瘘管和假性动脉瘤的形成。

结论

这种情况的危险在于导致突然的血流动力学崩溃,若无紧急手术干预则难以治疗,会导致灾难性状况和后果。因此,早期快速诊断仍然是治疗的基石。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9af8/11401152/ceb8bf214d48/gr1.jpg

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