Sasaki H, Kawai H, Sawamura T, Takiya H
Surgery of Oota Hospital, Gifu, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Aug;41(8):1373-7.
A 39-year-old man who had undergone the patch closure of the VSD 15 years ago, was admitted with a diagnosis of infective endocarditis due to Alcaligenes Xylosoxidans. Echocardiography revealed vegetation of the aortic valve and a high echoic lesion on the ventricular septum. Surgical findings showed vegetation of the aortic valve and a subannular type mycotic aneurysm. In the aneurysm, the infected pledget used in a previous surgery was found. After debridement, direct closure of the aneurysm, aortic valve replacement (AVR) using a #25 SJM prosthetic valve, and mitral annuloplasty were performed. Two months later, fever developed. The patient was diagnosed with prosthetic valve endocarditis and a second surgery was performed. The prosthetic valve was clear, but an infected Dacron patch used for VSD closure 15 years earlier was found. Debridement, patch closure of the ventricular septum, and re-AVR were performed. The post-operative course was uneventful. This is thought to be a rare case, because infection extended from the aortic valve to the VSD type II Dacron patch, and remained to the VSD type II Dacron patch.
一名39岁男性，15年前曾接受室间隔缺损修补术，因木糖氧化产碱杆菌感染性心内膜炎入院。超声心动图显示主动脉瓣赘生物及室间隔高回声病变。手术发现主动脉瓣赘生物及瓣环下型霉菌性动脉瘤。在动脉瘤内发现了先前手术中使用的感染性棉片。清创后，直接闭合动脉瘤，使用25号圣犹达机械瓣进行主动脉瓣置换术（AVR），并进行二尖瓣环成形术。两个月后，患者发热。诊断为人工瓣膜心内膜炎，遂进行二次手术。人工瓣膜未见异常，但发现了15年前用于室间隔缺损修补的感染性涤纶补片。进行了清创、室间隔缺损补片修补及再次AVR。术后恢复顺利。这被认为是一例罕见病例，因为感染从主动脉瓣蔓延至II型涤纶补片室间隔缺损处，并残留于II型涤纶补片室间隔缺损处。
