Spyridopoulos I, Helber U, Mewis C, Voelker W, Steinhilber B, Schulze H J, Huppert P, Hoffmeister H M
Department of Cardiology, University of Tuebingen, Germany.
J Cardiovasc Surg (Torino). 1996 Oct;37(5):517-20.
The case of an non-addict young caucasian with isolated tricuspid valve endocarditis in congenital ventricular septal defect (VSD) is presented. Despite antibiotic treatment the patient suffered from recurrent right sided pneumonias. A computed tomography of the chest revealed an abscess localized in the right lower lung with signs of cavitation. Echocardiography identified a vegetation located at the anterior tricuspid leaflet due to a jet lesion through the VSD. ECG-gated MRI revealed normal left ventricular function and localized the septal defect and a jet against the anterior tricuspid valve leaflet. The patient underwent open heart surgery and the VSD was closed. Now, two years later, the patient is free from any symptoms or complications. This case illustrates that noninvasive techniques like echocardiography and ECG-gated MRI can not only accurately image cardiac anatomy in patients with ventricular septal defect but additionally provide information about the pathomechanism of the development of jet lesions resulting in valvular vegetations. Operative correction of underlying cardiac disease in nonaddicts with complicating tricuspid valve endocarditis might be a favourable treatment especially when antibiotic treatment fails to cure the infection.
本文介绍了一名非成瘾性年轻白种人患者，其先天性室间隔缺损（VSD）合并孤立性三尖瓣心内膜炎。尽管接受了抗生素治疗，但患者仍反复出现右侧肺炎。胸部计算机断层扫描显示右下肺有一个脓肿，并有空洞形成迹象。超声心动图发现由于室间隔缺损处的喷射性病变，在前三尖瓣叶上有一个赘生物。心电图门控磁共振成像显示左心室功能正常，定位了室间隔缺损以及指向前三尖瓣叶的喷射血流。患者接受了心脏直视手术，室间隔缺损得以闭合。现在，两年过去了，患者没有任何症状或并发症。该病例表明，超声心动图和心电图门控磁共振成像等非侵入性技术不仅可以准确地对室间隔缺损患者的心脏解剖结构进行成像，还能额外提供有关导致瓣膜赘生物的喷射性病变发展的病理机制信息。对于合并三尖瓣心内膜炎并发症的非成瘾性患者，对潜在心脏病进行手术矫正可能是一种有效的治疗方法，尤其是在抗生素治疗无法治愈感染的情况下。
