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人工瓣膜心内膜炎与主动脉根部脓肿：一例高风险感染病例

Prosthetic Valve Endocarditis and Aortic Root Abscess: A Case of High-Risk Infection.

作者信息

Imran Alisha, Quarrell Andrew, Edhem Leyan, Eni Gedoni, Ahmed Adnan, Solano Jhiamluka

机构信息

Cardiology, Northern Lincolnshire and Goole NHS Foundation Trust, Grimsby, GBR.

General Surgery, Scunthorpe General Hospital, Scunthorpe, GBR.

出版信息

Cureus. 2025 Apr 11;17(4):e82063. doi: 10.7759/cureus.82063. eCollection 2025 Apr.

DOI:10.7759/cureus.82063
PMID:40357066
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12067022/
Abstract

Aortic root abscess is a severe complication of infective endocarditis (IE), particularly in patients with prosthetic valves, nearly doubling mortality risk. Due to the potential for rupture and systemic spread, urgent surgical intervention is recommended. We present the case of a 77-year-old man with a recent aortic valve replacement and a history of discitis who presented with non-specific symptoms, complete heart block, and persistent bacteremia. Multimodal imaging, including positron emission tomography (PET) and CT coronary angiography, confirmed an aortic root abscess. Following the IE multidisciplinary team (MDT) recommendations, the patient underwent successful aortic valve and root repair. Post-operatively, he required a pacemaker and dual antibiotic therapy for eight weeks, with no further infection detected. This case highlights the diagnostic challenges of prosthetic valve endocarditis, the critical role of multimodal imaging in detecting complications, and the necessity of early surgical intervention. The development of a heart block underscores the impact of aortic root abscess on conduction pathways. MDT management was essential in optimising patient outcomes.

摘要

主动脉根部脓肿是感染性心内膜炎（IE）的一种严重并发症，尤其在人工瓣膜置换患者中，死亡风险几乎翻倍。由于存在破裂和全身扩散的可能性，建议进行紧急手术干预。我们报告一例77岁男性病例，该患者近期接受主动脉瓣置换术，有椎间盘炎病史，表现为非特异性症状、完全性心脏传导阻滞和持续性菌血症。包括正电子发射断层扫描（PET）和CT冠状动脉造影在内的多模态成像证实了主动脉根部脓肿。按照IE多学科团队（MDT）的建议，患者成功接受了主动脉瓣和根部修复手术。术后，他需要起搏器和为期八周的双联抗生素治疗，未检测到进一步感染。该病例凸显了人工瓣膜心内膜炎的诊断挑战、多模态成像在检测并发症中的关键作用以及早期手术干预的必要性。心脏传导阻滞的出现强调了主动脉根部脓肿对传导通路的影响。MDT管理对于优化患者预后至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/9a7fc26e02ea/cureus-0017-00000082063-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/8052efe621f8/cureus-0017-00000082063-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/58087ebe15ff/cureus-0017-00000082063-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/62accb94b265/cureus-0017-00000082063-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/9a7fc26e02ea/cureus-0017-00000082063-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/8052efe621f8/cureus-0017-00000082063-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/58087ebe15ff/cureus-0017-00000082063-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/62accb94b265/cureus-0017-00000082063-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38f5/12067022/9a7fc26e02ea/cureus-0017-00000082063-i04.jpg

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本文引用的文献

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J Cardiovasc Dev Dis. 2023 Aug 6;10(8):338. doi: 10.3390/jcdd10080338.
2
2023 ESC Guidelines for the management of endocarditis.2023年欧洲心脏病学会感染性心内膜炎管理指南。
Eur Heart J. 2023 Oct 14;44(39):3948-4042. doi: 10.1093/eurheartj/ehad193.
3
Aortic Root Abscess Presenting As Chest Pain and Ischemic EKG Changes: Importance of Timely Diagnosis.以胸痛和缺血性心电图改变为表现的主动脉根部脓肿：及时诊断的重要性。
Cureus. 2023 Apr 26;15(4):e38138. doi: 10.7759/cureus.38138. eCollection 2023 Apr.
4
Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess - systematic review and meta-analysis.主动脉瓣心内膜炎合并主动脉根部脓肿的手术治疗效果及最佳治疗方法：系统评价和荟萃分析。
Perfusion. 2024 Mar;39(2):256-265. doi: 10.1177/02676591221137484. Epub 2022 Oct 31.
5
Aortic root abscess from infective endocarditis: Case report and brief review of the literature.感染性心内膜炎所致主动脉根部脓肿：病例报告及文献简要综述
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6
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Front Cardiovasc Med. 2022 May 31;9:875870. doi: 10.3389/fcvm.2022.875870. eCollection 2022.
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