PDF(Pubmed)
Abstract：
BACKGROUND: Although the true prevalence and incidence are not clearly known, mycotic pulmonary artery aneurysm is a potentially devastating condition that leads to high mortality, over 60% if untreated. Among them, mycotic pulmonary artery pseudoaneurysm, which occurs in relatively central areas, has rarely been reported. We report an extremely rare case of a late complication with a mycotic pulmonary artery pseudoaneurysm, presumably due to infective endocarditis, in a 68-year-old woman 4 months after total arch replacement.
METHODS: A 68-year-old woman was referred to our department for 2 weeks with fever of unknown origin. She had a history of emergency total arch replacement for an acute type A aortic dissection 4 months earlier and chronic rheumatoid arthritis on monthly subcutaneous tocilizumab treatment for several years. Blood culture was positive for Enterococcus faecalis. Transthoracic and transesophageal echocardiography revealed a left ventricular ejection fraction of 58%, severe mitral regurgitation with a 15-mm diameter vegetation on the anterior mitral leaflet, and severe aortic insufficiency with string-like structures. Contrast computed tomography showed a focal saccular outpouching from the right pulmonary artery. On 18F-fluorodeoxyglucose (FDG) positron emission tomography, focal uptake of FDGs was observed along the same lesion of the pulmonary artery and ascending-arch graft. The patient eventually recovered after the surgical intervention of mitral and aortic valve replacement, re-total arch replacement, pulmonary artery repair, application of omental flap, and antibiotics without any evidence of re-infection after 1 year.
CONCLUSIONS: We report a successful surgical repair of mycotic pulmonary artery pseudoaneurysm 4 months after total arch replacement for acute type A aortic dissection. This report describes an effective treatment for an extremely rare postoperative condition.
METHODS: A 68-year-old woman was referred to our department for 2 weeks with fever of unknown origin. She had a history of emergency total arch replacement for an acute type A aortic dissection 4 months earlier and chronic rheumatoid arthritis on monthly subcutaneous tocilizumab treatment for several years. Blood culture was positive for Enterococcus faecalis. Transthoracic and transesophageal echocardiography revealed a left ventricular ejection fraction of 58%, severe mitral regurgitation with a 15-mm diameter vegetation on the anterior mitral leaflet, and severe aortic insufficiency with string-like structures. Contrast computed tomography showed a focal saccular outpouching from the right pulmonary artery. On 18F-fluorodeoxyglucose (FDG) positron emission tomography, focal uptake of FDGs was observed along the same lesion of the pulmonary artery and ascending-arch graft. The patient eventually recovered after the surgical intervention of mitral and aortic valve replacement, re-total arch replacement, pulmonary artery repair, application of omental flap, and antibiotics without any evidence of re-infection after 1 year.
CONCLUSIONS: We report a successful surgical repair of mycotic pulmonary artery pseudoaneurysm 4 months after total arch replacement for acute type A aortic dissection. This report describes an effective treatment for an extremely rare postoperative condition.
摘要：
背景：尽管尚不清楚真实的患病率和发病率，霉菌性肺动脉瘤是一种潜在的破坏性疾病，会导致高死亡率，如果未经处理，超过60%。其中,真菌性肺动脉假性动脉瘤,发生在相对中心的地区，很少有报道。我们报告了一例极为罕见的晚期并发症，伴有真菌性肺动脉假性动脉瘤，可能是感染性心内膜炎,一名68岁的女性在全足弓置换4个月后。
方法：一名68岁女性因不明原因发热被转诊到我们部门2周。她有4个月前因急性A型主动脉夹层和慢性类风湿性关节炎进行紧急全足弓置换的病史，每月皮下托珠单抗治疗数年。血培养粪肠球菌阳性。经胸和经食道超声心动图显示左心室射血分数为58%，严重的二尖瓣反流，二尖瓣前小叶上有15毫米直径的植被，和伴有线状结构的严重主动脉瓣关闭不全。对比计算机断层扫描显示，右肺动脉出现局灶性囊状外袋。在18F-氟代脱氧葡萄糖（FDG）正电子发射断层扫描中，沿肺动脉和升弓移植物的同一病变观察到FDG的局灶性摄取。患者在二尖瓣和主动脉瓣置换术后最终康复，重新全足弓置换，肺动脉修复,应用网膜瓣，和抗生素在1年后没有任何再感染的证据。
结论：我们报告了在急性A型主动脉夹层全弓置换4个月后成功修复了真菌性肺动脉假性动脉瘤。本报告描述了一种极其罕见的术后疾病的有效治疗方法。
方法：一名68岁女性因不明原因发热被转诊到我们部门2周。她有4个月前因急性A型主动脉夹层和慢性类风湿性关节炎进行紧急全足弓置换的病史，每月皮下托珠单抗治疗数年。血培养粪肠球菌阳性。经胸和经食道超声心动图显示左心室射血分数为58%，严重的二尖瓣反流，二尖瓣前小叶上有15毫米直径的植被，和伴有线状结构的严重主动脉瓣关闭不全。对比计算机断层扫描显示，右肺动脉出现局灶性囊状外袋。在18F-氟代脱氧葡萄糖（FDG）正电子发射断层扫描中，沿肺动脉和升弓移植物的同一病变观察到FDG的局灶性摄取。患者在二尖瓣和主动脉瓣置换术后最终康复，重新全足弓置换，肺动脉修复,应用网膜瓣，和抗生素在1年后没有任何再感染的证据。
结论：我们报告了在急性A型主动脉夹层全弓置换4个月后成功修复了真菌性肺动脉假性动脉瘤。本报告描述了一种极其罕见的术后疾病的有效治疗方法。
