PDF(Pubmed)
Abstract：
BACKGROUND: This case highlights several complications of a late and rare presentation of culture-negative Streptococcus pyogenes endocarditis of a previously repaired mitral valve with an annuloplasty ring including recurrent cardioembolic strokes, which was initially missed on transthoracic echocardiography.
METHODS: A 66-year-old Caucasian female with prior mitral valve prolapse status post mitral valve annuloplasty and left atrial appendage occlusion, followed by two strokes, presented with supraventricular tachycardia that resolved spontaneously. During an inpatient admission, she developed symptoms of another stroke, and imaging studies were suggestive of recurrent cardioembolic phenomenon. Additional workup revealed two small intra-atrial masses adherent to the mitral annuloplasty ring missed on prior evaluation for recurrent stroke. She underwent surgical repair in the setting of a chronic culture-negative infectious endocarditis with Streptococcus pyogenes and recovered well with no further cardioembolic phenomenon.
CONCLUSIONS: This case serves to highlight the importance of having a higher index of suspicion in any cardiac prosthesis patient for endocarditis when presenting with symptoms such as recurrent stroke, arrhythmias, and abnormal cardiac lab work. It also demonstrates the need for appropriate imaging with transthoracic echocardiography followed by transesophageal echocardiography and reviews surgical indications to diagnose and treat culture-negative endocarditis.
METHODS: A 66-year-old Caucasian female with prior mitral valve prolapse status post mitral valve annuloplasty and left atrial appendage occlusion, followed by two strokes, presented with supraventricular tachycardia that resolved spontaneously. During an inpatient admission, she developed symptoms of another stroke, and imaging studies were suggestive of recurrent cardioembolic phenomenon. Additional workup revealed two small intra-atrial masses adherent to the mitral annuloplasty ring missed on prior evaluation for recurrent stroke. She underwent surgical repair in the setting of a chronic culture-negative infectious endocarditis with Streptococcus pyogenes and recovered well with no further cardioembolic phenomenon.
CONCLUSIONS: This case serves to highlight the importance of having a higher index of suspicion in any cardiac prosthesis patient for endocarditis when presenting with symptoms such as recurrent stroke, arrhythmias, and abnormal cardiac lab work. It also demonstrates the need for appropriate imaging with transthoracic echocardiography followed by transesophageal echocardiography and reviews surgical indications to diagnose and treat culture-negative endocarditis.
摘要：
背景：该病例突出了一些罕见的晚期和罕见的培养阴性化脓性链球菌心内膜炎的并发症，该并发症是先前修复的二尖瓣并带有瓣环成形术环，包括复发性心源性中风，最初是经胸超声心动图漏诊的。
方法：一名66岁的白种人女性，在二尖瓣瓣环成形术和左心耳封堵后出现二尖瓣脱垂，接着是两个笔画，表现为自发消退的室上性心动过速。在住院期间，她又出现了中风的症状,影像学检查提示心脏栓塞复发。进一步的检查显示，在先前评估复发性中风时，错过了两个粘附在二尖瓣环成形术环上的小心房内肿块。在化脓性链球菌慢性培养阴性感染性心内膜炎的情况下，她接受了手术修复，恢复良好，没有进一步的心脏栓塞现象。
结论：该病例强调了在任何心脏假体患者中，当出现复发性中风等症状时，有更高的怀疑心内膜炎指数的重要性。心律失常,和异常的心脏实验室工作。它还表明需要经胸超声心动图，然后经食道超声心动图进行适当的成像，并回顾手术适应症以诊断和治疗培养阴性心内膜炎。
方法：一名66岁的白种人女性，在二尖瓣瓣环成形术和左心耳封堵后出现二尖瓣脱垂，接着是两个笔画，表现为自发消退的室上性心动过速。在住院期间，她又出现了中风的症状,影像学检查提示心脏栓塞复发。进一步的检查显示，在先前评估复发性中风时，错过了两个粘附在二尖瓣环成形术环上的小心房内肿块。在化脓性链球菌慢性培养阴性感染性心内膜炎的情况下，她接受了手术修复，恢复良好，没有进一步的心脏栓塞现象。
结论：该病例强调了在任何心脏假体患者中，当出现复发性中风等症状时，有更高的怀疑心内膜炎指数的重要性。心律失常,和异常的心脏实验室工作。它还表明需要经胸超声心动图，然后经食道超声心动图进行适当的成像，并回顾手术适应症以诊断和治疗培养阴性心内膜炎。
