妊娠合并感染性心内膜炎1例

Infective endocarditis in pregnancy:A case report

1病例资料患者,31岁,因孕30^(+5)周,间断胸闷、憋气2个月,发热10 d而就诊。患者末次月经2019年10月19日,预产期2020年7月26日。孕20^(+)周出现胸闷、憋气,平卧入睡有明显不适,未就诊;孕24^(+)周起胸闷、憋气较前加重,爬二层楼梯需要休息,于建档医院查血红蛋白波动于84~85 g/L,考虑与妊娠及贫血有关,建议观察;此后胸闷、憋气症状逐渐加重。

Infective endocarditis in pregnancy is extremely rare in clinical practice.Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy,and case reports on infective endocarditis are scarce.Due to increased blood volume and hemodynamic changes in late pregnancy,endocardial neoplasms are easy to fall off and cause systemic or pulmonary embolism,respiratory,cardiac arrest and sudden death may occur in pregnant women,the fetus can suffer from intrauterine distress and stillbirth at any time,leading to adverse outcomes for pregnant women and fetuses.The disease is dangerous and difficult to treat,which seriously threatens the lives of mothers and babies.Early diagnosis and reasonable treatment can effectively improve the prognosis of patients.The most important method for the treatment of infective endocarditis requires early,adequate,long-term and combined antibiotic therapy.Moreover,surgical controversies regarding indication and timing of treatment exist,especially in pregnancy.In terms of the timing of termination of pregnancy,the timing of cardiac surgery,and the method of surgery,individualized programs must be adopted.A pregnant woman with 30^(+5) weeks of gestation is reported.She was admitted to hospital due to intermittent chest tightness,suffocation and fever,with gradeⅢcardiac insufficiency.Imaging revealed large mitral valve vegetation,22.0 mm×4.1 mm and 22.0 mm×5.1 mm,respectively,and severe valve regurgitation.Mitral valve perforation was more likely,blood culture suggested Staphylococcus epidermidis infection,after antibiotic conservative treatment,the effect was poor.After the joint consultation including cardiology,neonatology,interventional vascular surgery,anesthesiology,and obstetrics,the combined operation of obstetrics and cardiac surgery was performed in time.The heart was blocked for 60 minutes,the bleeding was 1200 mL,the newborn was mildly asphyxiated after birth,and the birth weight was 1890 g.Nine days after the operation,the patient was discharged from the hospital,and the newborn was discharged with the weight of 2020 g.Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child.An optimal outcome in a challenging case like this greatly depends on effective interdisciplinary communication,informed consent of the patient,and concerted action among the specialists involved.