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人工瓣膜心内膜炎所致的心源性栓塞性卒中:一例报告

Cardioembolic Stroke Due to Prosthetic Valve Endocarditis Caused by : A Case Report.

作者信息

Affas Mohammad Nasser, Chawa Yamane, Khalil Mohammad Salem, Alkodmani Sham

机构信息

Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.

出版信息

Case Rep Infect Dis. 2024 Nov 9;2024:5581547. doi: 10.1155/2024/5581547. eCollection 2024.

Abstract

Embolic stroke due to prosthetic valve endocarditis (PVE) caused by is a rare and serious complication. Successful management requires a combination of medical and surgical approaches. We present a case full of complexities in diagnosing and managing PVE, emphasizing the importance of a multidisciplinary approach. A 50 year-old male presented to the emergency department with vertigo and low-grade fever and was found to have cerebellar stroke likely from the cardioembolic origin, and the patient had a history of uncontrolled diabetes and double prosthetic valves. The diagnosis was challenging and required transesophageal echocardiography (TEE) which showed two vegetations attached to the mitral valve prosthesis. The management involved antifungal therapy, but surgery was hindered by financial issues. The patient was considered for the AngioVac vegetation aspiration system due to persistent fungemia. Eventually, surgery was not performed, and the patient was discharged with a plan for long-term suppressive antifungal therapy.

摘要

人工瓣膜心内膜炎(PVE)所致的栓塞性中风是一种罕见且严重的并发症。成功的治疗需要药物和手术方法相结合。我们呈现了一例在诊断和管理PVE方面充满复杂性的病例,强调了多学科方法的重要性。一名50岁男性因眩晕和低热就诊于急诊科,被发现可能因心源性栓塞导致小脑中风,该患者有未控制的糖尿病病史且植入了双枚人工瓣膜。诊断颇具挑战性,需要经食管超声心动图(TEE)检查,结果显示二尖瓣人工瓣膜上附着有两个赘生物。治疗包括抗真菌治疗,但由于经济问题手术受阻。由于持续存在真菌血症,考虑为患者使用AngioVac赘生物抽吸系统。最终未进行手术治疗,患者出院时制定了长期抑制性抗真菌治疗计划。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6775/11568888/a7c5b8f57e03/CRIID2024-5581547.001.jpg

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