Hirata Yuki, Toriumi Shinichi, Harada Kenji, Hoshide Satoshi, Kario Kazuomi
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan.
Eur Heart J Case Rep. 2024 Dec 10;8(12):ytae633. doi: 10.1093/ehjcr/ytae633. eCollection 2024 Dec.
Although transcatheter aortic valve implantation (TAVI) is performed for very elderly patients in whom surgical aortic valve replacement (SAVR) poses unacceptably high operative risk, some of these patients are ultimately forced to undergo open surgery when TAVI is complicated by infective endocarditis (IE). To our knowledge, there have been no reports of cases with periannular extension of IE and atrioventricular block successfully treated by antibiotics without valve replacement.
An 80-year-old Japanese man who had undergone TAVI developed IE with loss of consciousness on Day 39 after the procedure. Methicillin-resistant was detected in his blood culture. Electrocardiography (ECG) showed complete atrioventricular block. Transoesophageal echocardiography (TEE) detected vegetation on the anterior mitral leaflet, aorta, and common annulus. Transcatheter aortic valve implantation had been performed rather than SAVR to avoid the associated operative risks. Because his haemodynamic condition was stable, we decided upon antibiotic treatment alone. On Day 42 after admission, TEE showed a reduction in the size of the vegetation, and his ECG recovered to sinus rhythm.
Medical treatment alone was effective for a periannular extension of IE complicated with complete atrioventricular block in a very elderly patient after TAVI had been performed to avoid high operative risk.
尽管经导管主动脉瓣植入术（TAVI）适用于外科主动脉瓣置换术（SAVR）手术风险高得难以接受的高龄患者，但当TAVI并发感染性心内膜炎（IE）时，其中一些患者最终不得不接受开胸手术。据我们所知，尚无关于IE瓣周扩展合并房室传导阻滞且未经瓣膜置换而通过抗生素成功治疗的病例报告。
一名80岁日本男性在接受TAVI术后第39天发生IE并出现意识丧失。血培养检出耐甲氧西林金黄色葡萄球菌。心电图（ECG）显示完全性房室传导阻滞。经食管超声心动图（TEE）检测到二尖瓣前叶、主动脉和共同瓣环有赘生物。为避免相关手术风险，该患者接受的是TAVI而非SAVR。由于其血流动力学状况稳定，我们决定仅采用抗生素治疗。入院后第42天，TEE显示赘生物大小减小，其ECG恢复为窦性心律。
对于一名因避免高手术风险而接受TAVI术后的高龄患者，单纯药物治疗对IE瓣周扩展合并完全性房室传导阻滞有效。
