Rizzo Martina, Cameli Matteo, Marianello Daniele, Franchi Federico, Andriani Stefano, Lorusso Roberto, Montesi Gianfranco, Gelsomino Sandro
Department of Cardiothoracic Surgery, School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands.
Cardiac Surgery Unit, Cardiothoracic and Vascular Disease Department, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy.
JACC Case Rep. 2024 Nov 6;29(21):102697. doi: 10.1016/j.jaccas.2024.102697.
A paradigmatic case is presented of subarachnoid hemorrhage as the initial sign of bacterial endocarditis on a mechanical cardiac prosthesis, in the absence of symptoms and echocardiographic evidence of infective endocarditis and vegetation. The presentation emphasizes the need to pursue a diagnostic workup for bacterial endocarditis whenever a patient with a mechanical prosthesis presents to the emergency department with focal neurologic signs. In addition, it highlights the potential use of second-level diagnostic tools to assess the extent of abscess presence and lesion extension to other cardiac structures for proper surgical planning. Finally, the presented case confirms that cardiopulmonary bypass surgery is not contraindicated and should not be delayed, even in the presence of extensive endocardial lesions with concurrent subarachnoid hemorrhage.
本文呈现了一个典型病例，一名接受机械心脏瓣膜置换术的患者，以蛛网膜下腔出血作为细菌性心内膜炎的初始症状，且当时并无感染性心内膜炎及赘生物的症状和超声心动图证据。该病例表明，每当有机械瓣膜置换史的患者因局灶性神经体征就诊于急诊科时，都有必要对细菌性心内膜炎进行诊断性检查。此外，它还强调了使用二级诊断工具评估脓肿范围以及病变向其他心脏结构扩展情况对于进行恰当手术规划的潜在作用。最后，该病例证实，即使存在广泛的心内膜病变并发蛛网膜下腔出血，体外循环手术也并非禁忌，不应延迟进行。
