Omran H, Reichel H, Wirtz P, Jung W, Rabahieh R, Pfeifer U, Pfeiffer D, Lüderitz B
Medizinische Klinik und Poliklinik, Rheinischen Friedrich-Wilhelms-Universität Bonn.
Dtsch Med Wochenschr. 1997 Feb 7;122(6):156-60. doi: 10.1055/s-2008-1047590.
A 68-year-old woman was hospitalized because of fever and tiredness for 3 months. Her general condition was clearly impaired. She had a mild fever of 38.5 degrees C and on auscultation a 3/6 systolic murmur, maximal parasternally in the 3rd intercostal space, transmitted to the apex. There were distant râles over both lungs, the neck veins were distended and there was ankle oedema.
C-reactive protein was raised to 17.3 mg/dl (normal up to 0.9 mg/dl), WBC count 19,300/microliter. beta-haemolysing streptococcus (S. agalactiae) was grown in the blood culture. The ECG showed sinus tachycardia (rate of 98/min) and transthoracic echocardiography demonstrated a small pericardial, enlarged ventricles, marked mitral regurgitation and a large vegetation on the posterior mitral leaflet, as well as a 3 x 4 cm mass in the posterior wall of the ventricle, originating from the posterior mitral valve ring and communicating with the vegetation on the mitral valve. The posterior mitral leaflet was perforated.
As endocarditis of the mitral valve with a complicated course was suspected-abscess of the posterior mitral valve ring and septic myocardial aneurysm with associated pericarditis and haemodynamically insignificant effusion-she was transferred to the intensive care unit where she died suddenly of circulatory arrest only 30 min after transfer. Autopsy confirmed the echocardiographic findings.
Paravalvular abscess in the course of mitral valve endocarditis is rare, but should be looked for at transthoracic echocardiography so that any necessary surgical intervention can be undertaken early.
一名68岁女性因发热和疲倦3个月入院。她的一般状况明显受损。体温轻度升高至38.5℃，听诊可闻及3/6级收缩期杂音，在胸骨旁第3肋间最响，可传导至心尖。双肺可闻及湿啰音，颈静脉怒张，伴有脚踝水肿。
C反应蛋白升高至17.3mg/dl（正常上限为0.9mg/dl），白细胞计数为19300/微升。血培养培养出β溶血性链球菌（无乳链球菌）。心电图显示窦性心动过速（心率98次/分钟），经胸超声心动图显示心包少量积液、心室扩大、明显的二尖瓣反流、二尖瓣后叶有一个大的赘生物，以及心室后壁有一个3×4cm的肿块，起源于二尖瓣后瓣环并与二尖瓣上的赘生物相连。二尖瓣后叶穿孔。
由于怀疑为二尖瓣心内膜炎且病程复杂——二尖瓣后瓣环脓肿、感染性心肌瘤合并心包炎及血流动力学上无显著意义的积液——她被转入重症监护病房，转入后仅30分钟就因循环骤停突然死亡。尸检证实了超声心动图检查结果。
二尖瓣心内膜炎过程中的瓣周脓肿罕见，但应在经胸超声心动图检查时予以排查，以便能尽早进行必要的手术干预。
