PDF(Pubmed)
Abstract：
BACKGROUND: A fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention.
METHODS: A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4.
CONCLUSIONS: The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient\'s condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.
METHODS: A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4.
CONCLUSIONS: The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient\'s condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.
摘要：
背景：mitro主动脉瓣间纤维（MAIVF）中的瘘管是一种罕见的实体，表现为心内膜炎或手术创伤的并发症。一般来说,它与MAIVF(p-MAIVF)或主动脉脓肿的假性动脉瘤相关。MAIVF瘘可能导致毁灭性的并发症和高死亡率。这种情况是通过手术治疗的，通过经皮闭合或开放式手术方法。在此，我们报告了一例继发于细菌性心内膜炎的MAIVF瘘患者的复杂病例。进一步的临床恶化是由严重的主动脉瓣关闭不全和血流动力学受损引起的。需要手术干预.
方法：一名74岁的男性患者因不适而进入初级保健中心，虚弱,adynamia,缺氧,过去八天下肢水肿.他的既往病史为动脉高血压阳性，为单肾。进行了经食管超声心动图（TEE），表现出56％的左心室射血分数（LVEF）和复杂的主动脉瓣心内膜炎。通过开放方法进行的手术治疗包括植被切除，瓣膜置换,并关闭MAIVF瘘。完成抗生素治疗后，患者出院，无并发症。术后随访期间,患者仍然无症状，而对照超声心动图显示没有MAIVF瘘的迹象.4
结论：介绍了一例由链球菌引起的心内膜炎继发MAIVF瘘患者的临床病例。瘘管与p-MAIVF或主动脉脓肿无关，这些发现进一步恶化了患者的病情并增加了死亡的可能性。此病例通过心脏成像和及时手术闭合缺损，加强了及时诊断的重要性。
方法：一名74岁的男性患者因不适而进入初级保健中心，虚弱,adynamia,缺氧,过去八天下肢水肿.他的既往病史为动脉高血压阳性，为单肾。进行了经食管超声心动图（TEE），表现出56％的左心室射血分数（LVEF）和复杂的主动脉瓣心内膜炎。通过开放方法进行的手术治疗包括植被切除，瓣膜置换,并关闭MAIVF瘘。完成抗生素治疗后，患者出院，无并发症。术后随访期间,患者仍然无症状，而对照超声心动图显示没有MAIVF瘘的迹象.4
结论：介绍了一例由链球菌引起的心内膜炎继发MAIVF瘘患者的临床病例。瘘管与p-MAIVF或主动脉脓肿无关，这些发现进一步恶化了患者的病情并增加了死亡的可能性。此病例通过心脏成像和及时手术闭合缺损，加强了及时诊断的重要性。
