Fujiyama A, Nishiue T, Masaki M, Kurihara H, Iba O, Komatsu K, Maeda A, Senzaki H, Kawaguchi H, Imamura H, Iwasaka T
Second Department of Internal Medicine, Kansai Medical University, Osaka.
J Cardiol. 1998 Nov;32(5):331-6.
Annuloaortic ectasia is often accompanied by Marfan syndrome and associated with infective endocarditis usually involving the mitral valves. We treated a patient with annuloaortic ectasia due to idiopathic cystic medial necrosis who developed congestive heart failure with aortic valvular vegetation. A 56-year-old man had dyspnea on effort since the beginning of January, 1997 and was admitted to our hospital on April 6, 1997 because of orthopnea. The diagnosis was congestive heart failure due to severe aortic regurgitation with annuloaortic ectasia detected by echocardiography. Medication and rest after hospitalization relieved his symptoms but congestive heart failure deteriorated after he had a high fever. At this time, a vegetation attached to the noncoronary cusp of the aortic valve was found which had not been detected on admission. Blood culture yielded Streptococcus sanguis. The diagnosis was infective endocarditis involving the aortic valve. Surgical correction (Bentall method) improved congestive heart failure and he was discharged on August 4, 1997 without recurrence of endocarditis. Infective endocarditis involving the aortic valves is a possible cause of development or deterioration of congestive heart failure in patients with annuloaortic ectasia.
主动脉环扩张常伴有马方综合征，并与通常累及二尖瓣的感染性心内膜炎相关。我们治疗了一名因特发性囊性中层坏死导致主动脉环扩张的患者，该患者出现了伴有主动脉瓣赘生物的充血性心力衰竭。一名56岁男性自1997年1月初开始出现劳力性呼吸困难，并于1997年4月6日因端坐呼吸入住我院。诊断为超声心动图检测到的严重主动脉瓣反流伴主动脉环扩张所致的充血性心力衰竭。住院后药物治疗和休息缓解了他的症状，但在他出现高热后充血性心力衰竭恶化。此时，发现一个附着在主动脉瓣无冠瓣上的赘生物，入院时未检测到。血培养结果为血链球菌。诊断为累及主动脉瓣的感染性心内膜炎。手术矫正（Bentall法）改善了充血性心力衰竭，他于1997年8月4日出院，心内膜炎未复发。累及主动脉瓣的感染性心内膜炎可能是主动脉环扩张患者充血性心力衰竭发生或恶化的原因。
