Hirayama Daiki, Manabe Susumu, Yuge Norihisa
Cardiac Surgery, International University of Health and Welfare, Narita Hospital, Chiba, JPN.
Cureus. 2024 Oct 7;16(10):e70979. doi: 10.7759/cureus.70979. eCollection 2024 Oct.
Budd-Chiari syndrome (BCS) is a relatively rare comorbidity, particularly in patients undergoing cardiac surgery. The difficulty arises when we try to drain blood from the obstructed lower body circulation to establish extracorporeal circulation. Herein, we describe a patient who developed a persistent fever after undergoing neurosurgery for a head arteriovenous fistula, wherein blood cultures confirmed infection. The patient exhibited hyperbilirubinemia, hyperammonemia, and transient loss of consciousness. Transthoracic echocardiography showed moderate mitral regurgitation and 3 cm vegetation on the mitral valve. Imaging identified a thrombus in the right hepatic vein, stenosis of both the inferior vena cava and left hepatic vein, and esophagogastric and splenic varices. These findings led to establishing a diagnosis of infective endocarditis and BCS. The patient subsequently underwent mitral valve replacement with a mechanical valve. There are only a few case reports describing successful cardiac surgery in patients with BCS. Hence, we would like to report our surgical treatment of infective endocarditis complicated with BCS.
布加综合征（BCS）是一种相对罕见的合并症，在接受心脏手术的患者中尤为少见。当我们试图从受阻的下半身循环中引流血液以建立体外循环时，就会出现困难。在此，我们描述了一名因头部动静脉瘘接受神经外科手术后持续发热的患者，血培养证实存在感染。该患者出现高胆红素血症、高氨血症和短暂意识丧失。经胸超声心动图显示中度二尖瓣反流，二尖瓣上有3厘米的赘生物。影像学检查发现右肝静脉血栓形成，下腔静脉和左肝静脉狭窄，以及食管胃静脉曲张和脾静脉曲张。这些发现导致诊断为感染性心内膜炎和布加综合征。该患者随后接受了机械瓣膜二尖瓣置换术。仅有少数病例报告描述了布加综合征患者成功进行心脏手术的情况。因此，我们想报告我们对感染性心内膜炎合并布加综合征的手术治疗。
