Hirai H, Suehiro S, Kimura E, Nishizawa K, Shibata T, Kinoshita H
Second Department of Surgery, Osaka City University Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Aug;42(8):1193-7.
A 17-year-old boy, who had suffered from streptococcal infective endocarditis, was referred to our hospital because of the uncontrolled infection and severe right ventricular failure despite 2 months of vigorous antimicrobial therapy. Preoperative two-dimensional and Doppler echocardiography revealed a shunt from the left ventricule or aorta to the right atrium. Both aortic and tricuspid valves had vegetations and severe regurgitations. He underwent an operation because of the persistent infection and worsening heart failure. Intraoperatively, the aortic valve was found to be severely damaged and to have numerous vegetations on both surfaces. The tricuspid valve had multiple vegetations on the atrial surface only, and its annulus was markedly dilated. There was a perforation in the septal leaflet of the tricuspid valve, and an exploration of the focal site disclosed a perimembranous ventricular septal defect (VSD) communicating directly between the left ventricle and right atrium. Aortic and tricuspid valve replacements and patch closure of the VSD were done successfully and his postoperative course was uneventful except for the episode of ventricular tachycardia, torsade de pointes, on the fifth postoperative day.
一名17岁男孩，曾患链球菌感染性心内膜炎，尽管接受了2个月的积极抗菌治疗，但因感染无法控制且出现严重右心室衰竭而被转诊至我院。术前二维及多普勒超声心动图显示存在从左心室或主动脉至右心房的分流。主动脉瓣和三尖瓣均有赘生物且重度反流。由于持续感染和心力衰竭加重，他接受了手术。术中发现主动脉瓣严重受损，两面均有大量赘生物。三尖瓣仅在心房面有多个赘生物，其瓣环明显扩张。三尖瓣隔叶有穿孔，对病灶部位进行探查发现一个膜周部室间隔缺损（VSD），直接连通左心室和右心房。成功进行了主动脉瓣和三尖瓣置换以及VSD补片修补术，术后除了在术后第5天发生室性心动过速、尖端扭转型室速外，病程平稳。
