■d-大动脉转位(d-TGA)是一种先天性心脏缺陷,通常是致命的。那些在没有手术修复的情况下存活并且数量罕见的患者,需要足够的心内分流,将患有慢性紫癜。这里,我们介绍了一例罕见的病例,一例患有未修复的紫红色先天性心脏病(CHD)的成人,他患上了感染性心内膜炎(IE),我们还介绍了我们在这一罕见的困境中进行医疗决策的方法.
■一名52岁女性,患有未修复的d-TGA伴三尖瓣闭锁,右心室发育不良,无限制房间隔缺损,室间隔缺损,瓣膜下和肺动脉瓣狭窄伴发育不良,二叶肺动脉瓣表现为腹痛和缺氧,被发现患有急性肾梗塞。经胸超声心动图(TTE)显示二尖瓣上有大量活动。血液培养物生长出口腔链球菌,她被诊断出患有链球菌天然二尖瓣IE并伴有肾栓塞。她的左侧大量植被和栓塞现象有利于手术。然而,右心导管检查显示心内压正常,可能是与瓣膜下和瓣膜下肺动脉狭窄相关的多级梗阻保护肺血管免受过度循环和肺动脉高压的结果。心脏手术给她微妙平衡的血液动力学带来了极大的不稳定风险。因此,她用头孢曲松治疗4周。8周后的重复TTE显示了植被的分辨率。
■手术与手术的决定对于代偿性CHD成年患者,应在对每位患者独特的心脏血流动力学进行多学科评估后,并与患者共同决策后,对IE进行医学治疗.
UNASSIGNED: d-Transposition of the great arteries (d-TGA) is a congenital cardiac defect that is typically fatal. Those patients who survive without surgical repair and who are rare in number, need adequate intracardiac shunting and will suffer from chronic cyanosis. Here, we present a rare
case of an adult with unrepaired cyanotic congenital heart disease (CHD) who developed infective endocarditis (IE) and also our approach to the medical decision-making process in this uncommonly encountered dilemma.
UNASSIGNED: A 52-year-old female with unrepaired d-TGA with tricuspid atresia, hypoplastic right ventricle, unrestricted atrial septal defect, ventricular septal defect, and sub-valvular as well as valvular pulmonic stenosis with a hypoplastic, bicuspid pulmonary valve presented with abdominal pain and hypoxia and was found to have an acute renal infarct. Transthoracic echocardiogram (TTE) revealed a large mobile mass on the mitral valve. Blood cultures grew Streptococcus mitis-oralis and she was diagnosed with streptococcal native mitral valve IE complicated by a renal embolus. Her large left-sided vegetation and embolic phenomenon favoured surgery. However, a right heart catheterization showed normal intracardiac pressures, likely a result of multi-level obstruction relating to sub-valvular and valvular pulmonary stenosis protecting the pulmonary vasculature from over-circulation and pulmonary hypertension. Cardiac surgery posed a significant risk of destabilizing her delicately balanced haemodynamics. Hence, she was treated with ceftriaxone for 4 weeks. A repeat TTE 8 weeks later showed a resolution of the vegetation.
UNASSIGNED: A decision for surgery vs. medical treatment for IE in adult patients with compensated CHD should be made following a multi-disciplinary assessment of each patient\'s unique cardiac haemodynamics and after shared decision-making with the patient.