感染性心内膜炎并主动脉窦瘤行经导管主动脉瓣置换术一例

Transcatheter aortic valve replacement in infective endocarditis with aneurysm of aortic sinus: a case report

患者入院前行前列腺电切术,术后出现间断性发热,伴胸闷憋喘等症状,结合病史、症状、体征、相关实验室检查、超声心动图、影像学检查(CT)以及血培养示粪肠球菌阳性,诊断为主动脉瓣狭窄并关闭不全、二尖瓣关闭不全、心功能Ⅲ级(纽约心脏病学会分级)、感染性心内膜炎、主动脉窦瘤。抗菌药物治疗4周后,患者病情稳定,体温正常,多次血培养阴性,化验室相关检查正常。经过充分准备,患者在复合手术室实施经导管主动脉瓣置换术,应用32 mm Venus-A介入主动脉瓣膜,手术顺利,术后第7天出院。患者术后继续应用抗菌药物治疗4周,体温正常,无胸闷憋喘等症状。术后1、3、6个月复查血常规、红细胞沉降率均示正常,心电图示窦性心律,心脏超声示主动脉瓣最大跨瓣压差7 mm Hg(1 mm Hg=0.133 kPa)、无瓣周漏、无心包积液。

The patient underwent prostatectomy before two months. After the operation, he suffered from intermittent fever, chest tightness, and suffocation. Combined with the history, symptoms, signs, laboratory examination,echocardiography, imaging examination(CT), and the positive blood culture for Enterococcus faecalis, the admitting diagnosis was aortic stenosis and insufficiency, mitral insufficiency, cardiac function grade Ⅲ(New York Heart Association grade), infective endocarditis, and aneurysm of aortic sinus. After 4-week antimicrobial drug treatment, the patient was in a stable condition with normal body temperature, multiple negative blood cultures, and normal laboratoryrelated examinations. After careful and sufficient preparation, transcatheter aortic valve replacement operation was performed in the hybrid operating room with 32 mm Venus-A valve. The operation was successful and the patient was discharged on the seventh day after operation. He continued to be treated with antimicrobial drugs for 4 weeks after surgery, and his temperature was normal. He had no chest tightness, asthma, or other symptoms. One, three, and six months after operation, blood tests and erythrocyte sedimentation rate were normal, electrocardiogram showed sinus rhythm, and echocardiography showed a maximum aortic valve pressure difference of 7 mm Hg(1 mm Hg=0.133 kPa),no perivalvular leak and no pericardial effusion.