Nagashima K, Wada Y, Kawai T, Adachi S, Shunto K, Oka T
Department of Surgery, Children's Research Hospital, Kyoto University of Medicine, Japan.
Kyobu Geka. 1994 Nov;47(12):1026-8.
A 14-year-old boy who was operated on for left ventricular-right atrial shunt with bacterial and rheumatic endocarditis of the tricuspid valve (TV) is reported. The patient was pointed out perimembranous ventricular septal defect (VSD) at 4-month old and had complaint of occasional high fever for a half year. The echocardiography showed a vegetation at the TV. The vegetation did not disappear despite of administration of antibiotics for 2 weeks, and pulmonary embolism occurred. Then, the patient underwent resection of the vegetation and direct closure of VSD. The left ventricular-right atrial shunt was formed by the direct communication between VSD below TV annulus and the perforation of septal leaflet of TV adhered to the ventricular septum due to bacterial and rheumatic endocarditis. Earlier operation is needed for this type of case because antibiotics is not effective for the valvular disease.
报告了一名14岁男孩，他因左心室 - 右心房分流接受手术，患有三尖瓣细菌性和风湿性心内膜炎。该患者4个月大时被诊断为膜周部室间隔缺损（VSD），半年来时有高热主诉。超声心动图显示三尖瓣有赘生物。尽管使用抗生素治疗2周，赘生物仍未消失，且发生了肺栓塞。随后，患者接受了赘生物切除术及室间隔缺损直接闭合术。左心室 - 右心房分流是由于三尖瓣环下方的室间隔缺损与因细菌性和风湿性心内膜炎而附着于室间隔的三尖瓣隔叶穿孔直接相通形成的。对于这类病例，由于抗生素对瓣膜疾病无效，需要尽早手术。
