背景:真菌性心内膜炎是一种罕见但严重的疾病,与高死亡率相关。各种诱发因素促成了它的发生,比如潜在的心脏异常,心脏手术,人工心脏装置,和中央静脉导管.诊断真菌性心内膜炎,特别是曲霉,带来挑战,经常因阴性血培养而复杂化。
方法:本报告详细介绍了一例24岁男性的升主动脉广泛累及曲霉菌性心内膜炎(AE)的病例,该男性有生物瓣主动脉瓣置换术(AVR)的病史。AVR后三个月,他出现了心包积液和主动脉破裂,导致重做生物瓣膜导管主动脉根部置换术(Bentall手术)。尽管有干预,管状移植物表现出广泛的曲霉参与,导致移植物破裂和显著的主动脉周围感染。进行了第二次重做手术,涉及主动脉同种异体移植根置换。不幸的是,病人在手术后两天死亡。
结论:建议采用内科和外科联合治疗的方法治疗真菌性心内膜炎。尽管努力,与曲霉菌心内膜炎相关的死亡率仍然高得令人无法接受,联合治疗和单独抗真菌治疗之间没有显着差异。进一步的研究对于探索新的治疗策略和改善患有这种挑战性疾病的患者的预后至关重要。
BACKGROUND: Fungal endocarditis is a rare but serious condition associated with high mortality rates. Various predisposing factors contribute to its occurrence, such as underlying cardiac abnormalities, cardiac surgeries, prosthetic cardiac devices, and central venous catheters. Diagnosing fungal endocarditis, particularly Aspergillus, poses challenges, often complicated by negative blood cultures.
METHODS: This report details a
case of extensive ascending aorta involvement in Aspergillus endocarditis (AE) in a 24-year-old man with a history of
bioprosthesis aortic valve replacement (AVR). Three months post-AVR, he presented with pericardial effusion and aortic rupture, leading to a redo biological valved conduit aortic root replacement (Bentall surgery). Despite the intervention, the tubular graft exhibited extensive Aspergillus involvement, resulting in graft disruption and significant peri-aortic infection. A second redo procedure involving aortic homograft root replacement was performed. Unfortunately, the patient succumbed two days after the surgery.
CONCLUSIONS: A combined approach of medical and surgical therapies is recommended to manage fungal endocarditis. Despite efforts, the mortality rate associated with Aspergillus endocarditis remains unacceptably high, with no significant difference observed between combination therapy and antifungal treatment alone. Further research is essential to explore novel therapeutic strategies and improve outcomes for patients with this challenging condition.