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一例支持二尖瓣感染性心内膜炎合并复发性脑梗死早期手术治疗的病例报告。

A case report supporting early surgery in mitral valve infective endocarditis with recurrent cerebral infarcts.

作者信息

Kesieme Emeka B, Omoregbee Benjamin, Ngaage Dumbor L

机构信息

Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Rd, Cottingham HU16 5JQ, UK.

出版信息

Eur Heart J Case Rep. 2024 Dec 17;8(12):ytae641. doi: 10.1093/ehjcr/ytae641. eCollection 2024 Dec.

DOI:10.1093/ehjcr/ytae641
PMID:39691846
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11650381/
Abstract

BACKGROUND

In patients with infective endocarditis, brain embolism portends a poor prognosis. The timing of surgery in patients who require emergency valve surgery in the setting of deteriorating level of consciousness from recurrent embolic events, and brain infarction with haemorrhagic transformation, remains controversial.

CASE SUMMARY

We report a case of a 54-year-old male who presented with mitral valve endocarditis, recurrent episodes of cerebral embolic infarctions with haemorrhagic transformation and deteriorating level of consciousness, and successfully underwent emergency mitral valve surgery without extension of the preoperative cerebral embolic complication or worsening of neurological symptoms.

DISCUSSION

Mitral valve surgery can be performed successfully in patients with mitral valve endocarditis and cerebral embolism earlier than the recommended 2-4 weeks, and this should be considered in deteriorating patients.

摘要

背景

在感染性心内膜炎患者中，脑栓塞预示着预后不良。对于因反复栓塞事件导致意识水平恶化以及脑梗死伴出血转化而需要紧急瓣膜手术的患者，手术时机仍存在争议。

病例摘要

我们报告一例54岁男性患者，其患有二尖瓣心内膜炎，反复出现脑栓塞性梗死伴出血转化且意识水平恶化，成功接受了急诊二尖瓣手术，术前脑栓塞并发症未扩展，神经症状也未恶化。

讨论

二尖瓣心内膜炎和脑栓塞患者可在早于推荐的2 - 4周时间成功进行二尖瓣手术，对于病情恶化的患者应考虑这一点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26ff/11650381/982e72a4ce65/ytae641f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26ff/11650381/53e00b13dc59/ytae641il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26ff/11650381/982e72a4ce65/ytae641f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26ff/11650381/53e00b13dc59/ytae641il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26ff/11650381/982e72a4ce65/ytae641f1.jpg

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Critically ill patients with infective endocarditis, neurological complications and indication for cardiac surgery: a multicenter propensity-adjusted study.患有感染性心内膜炎、神经系统并发症且有心脏手术指征的危重症患者：一项多中心倾向调整研究。
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Management of Large Vessel Occlusion Stroke Related to Infective Endocarditis: Is Mechanical Thrombectomy a Safe Option?感染性心内膜炎相关大血管闭塞性卒中的管理：机械取栓是一种安全的选择吗？
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Risk of postoperative neurological exacerbation in patients with infective endocarditis and intracranial haemorrhage.感染性心内膜炎合并颅内出血患者术后神经功能恶化的风险。
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