主动脉瓣退行性病变并动脉导管未闭感染性心内膜炎1例

Aortic valve degenerative disease with patent ductus arteriosus infective endocarditis: A case report

感染性心内膜炎(infective endocarditis,IE)是指由病原微生物循血行途径引起的心内膜、心瓣膜或临近大动脉内膜的感染伴赘生物形成,心瓣膜为最常受累部位。本例患者,女,49岁,因长期发热首诊于呼吸内科,胸部CT示右肺尖部有一厚壁空洞,增强无强化,空洞内壁光整并见液平面,考虑感染性病变,结核待删;心脏彩超发现主动脉瓣赘生物,瓣周脓肿;血培养为粪肠球菌。外科行“主动脉瓣赘生物清除+主动脉瓣置换手术”,术中发现存在动脉导管未闭(patent ductus arteriosus,PDA),并缝闭动脉导管。主动脉瓣赘生物病理显示病变瓣膜组织中,隐见球菌菌落,符合瓣膜退行性病变合并感染的诊断。经血培养敏感药物万古霉素治疗6周后,肺部病灶较前明显吸收。由此可见患者肺部病灶是主动脉瓣菌栓脱落经未闭动脉导管进入肺循环而引起的。

Objective: Infective endocarditis (IE) refers to the pathogenic microbial infect the endocardium,valves or intima adjacent to the cardiac arteries through the bloodstream with the formation of vegetations.Valves are the most frequently aff ected sites.Here,we described a 49-year-old female, who admitt ed to respiratory outpatient department in the Th ird Xiangya Hospital,Central South University for long time of fever.Chest computer tomography (CT) found a thick wall cavity in the apex of the right lung with smooth wall and fluid plane,without enhancement,which was considered as inflammation and tuberculosis to be excluded.Echocardiography showed vegetations on the aortic valve,where abscess was found on the root.Accidentally in surgery,a patent ductus arteriosus (PDA) was found.The surgeon closed the PDA and performed aortic valve prosthetic valve replacement.Bacterial colony of coccus was found in the pathological tissue, which was consistent with the diagnosis of valvular degeneration with infection.Lung lesion was obviously absorbed after 6 weeks of treatment with vancomycin,which has been confirmed as a sensitive antibacterial drug to Enterococcus faecalis.Overall,the pulmonary lesion was caused by the detachment of bacterial neoplasm of aortic valve,which has passed through the PDA and entered the pulmonary circulation.