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伴有严重二尖瓣狭窄的快速进展性感染性心内膜炎

Rapidly Worsening Infective Endocarditis With Severe Mitral Stenosis.

作者信息

Yoshiyama Daiki, Morokuma Hiroyuki, Nagashima Kiyotaka, Baba Kouhei, Shichijo Masahide, Hayashi Nagi, Jinnouchi Kouki, Itoh Manabu, Yunoki Junji, Kamohara Keiji

机构信息

Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.

出版信息

JACC Case Rep. 2024 Nov 20;29(22):102764. doi: 10.1016/j.jaccas.2024.102764.

Abstract

Infective endocarditis (IE) rarely results in mitral stenosis (MS), but MS in patients with IE can be life-threatening. We present a case of prosthetic MS secondary to IE. A 69-year-old Japanese man underwent mitral valve replacement with a bioprosthetic valve 2 years previously. The patient presented with a 1-month history of illness, and we diagnosed prosthetic valve IE with severe MS and planned for time-sensitive surgery. However, the patient developed cardiogenic shock in response to prosthetic mitral valve obstruction while awaiting surgery. The patient then had to undergo emergency surgery. There are no management guidelines for IE-induced valve stenosis, whose treatment differs from that of valve regurgitation. Our literature review reveals that achieving survival in patients with MS secondary to IE is difficult without surgical intervention. Patients with MS caused by IE may require surgery, and specific criteria should be outlined in future guidelines.

摘要

感染性心内膜炎(IE)很少导致二尖瓣狭窄(MS),但IE患者的MS可能危及生命。我们报告一例继发于IE的人工二尖瓣狭窄病例。一名69岁的日本男性2年前接受了生物瓣二尖瓣置换术。该患者有1个月的病史,我们诊断为人工瓣膜IE伴严重MS,并计划进行限期手术。然而,患者在等待手术期间因人工二尖瓣梗阻出现心源性休克。患者随后不得不接受急诊手术。目前尚无针对IE引起的瓣膜狭窄的管理指南,其治疗方法与瓣膜反流不同。我们的文献综述显示,未经手术干预,继发于IE的MS患者很难存活。由IE引起的MS患者可能需要手术,未来的指南应明确具体标准。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd66/11646871/ff3dd87fee97/ga1.jpg

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