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.
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。