Chestier Y, Duval A, Luxereau P, Cabrol C, Acar J
Arch Mal Coeur Vaiss. 1978 Jan;71(1):25-32.
The case reported here concerns a female of 33 who presented, during the course of an acute bacterial aortitis which had been treated, with an inflammatory perforation of the membranous septum. The clinical picture consisted of an association of very severe heart failure with severe aortic incompetence, an apical pansystolic murmur, and atrioventricular conduction defects. Although it was carried out in the presence of active endocarditis (valve cultures positive for streptococci), operative intervention (Patch + Starr) allowed rapid healing and excellent cardiovascular function after a 30 month follow-up period. Careful study of this case and of the eleven others in the literature has enabled us to underline the following points:--the sudden appearance, in a case with infective aortic incompetence, of a gross pansystolic murmur associated with atrial or intraventricular conduction defects, should be taken as suggesting a septal perforation;--examination of the haemodynamic system in such a case runs certain risks, and should never be allowed to delay the operation, which must always be carried out urgently;--despite the unfavourable operative conditions, the results strongly support the need for surgical intervention in these patients in good time.
本文报道的病例为一名33岁女性，在治疗急性细菌性主动脉炎过程中出现膜性间隔炎性穿孔。临床表现为严重心力衰竭合并严重主动脉瓣关闭不全、心尖部全收缩期杂音及房室传导缺陷。尽管手术是在活动性心内膜炎（瓣膜培养链球菌阳性）情况下进行的，但手术干预（补片+斯塔尔手术）使患者在30个月的随访期后迅速愈合且心血管功能良好。对该病例及文献中其他11例病例的仔细研究使我们能够强调以下几点：——在感染性主动脉瓣关闭不全病例中，突然出现与心房或室内传导缺陷相关的明显全收缩期杂音，应提示存在间隔穿孔；——对此类病例进行血流动力学系统检查存在一定风险，绝不应因之延误手术，手术必须始终紧急进行；——尽管手术条件不利，但结果有力支持应及时对这些患者进行手术干预。
