经导管主动脉瓣植入术(TAVI)越来越多地用于治疗严重的主动脉瓣狭窄,主要是老年和/或医学上有缺陷的患者,由于其微创性质。与任何瓣膜置换程序一样,心内膜炎是公认的并发症,在TAVI患者中更是如此,合并症在其中非常普遍。我们报告了一名70岁的男性,有肝硬化病史,最近有TAVI,表现为反复发烧和持续的戊糖片菌血症。心内膜炎的诊断延迟,因为微生物最初作为污染物被丢弃,考虑到球菌很少被描述为人类病原体。然而,在肝硬化患者中,微生物群可能导致间歇性菌血症,从而影响人工瓣膜。经胸超声心动图对证实诊断没有帮助,就像TAVI患者的情况一样。经食管超声心动图被认为是危险的,由于食管静脉曲张使潜在的肝硬化复杂化。因此,心内膜炎的诊断基于持续菌血症和Duke's标准,包括高烧,诱发性心脏病,脾梗死,以及排除替代诊断。此外,肝硬化增加了治疗的副作用,并导致需要改变治疗方案和延长住院时间。鉴于局势的不稳定,通过2-脱氧-2-[氟-18]氟-D-葡萄糖正电子发射断层扫描-计算机断层扫描(18F-FDGPET-CT)扫描证实治疗成功.这是肝硬化患者中第一例报道的TAVI片球菌心内膜炎,强调了在诊断和治疗同时存在的TAVI心内膜炎患者中的独特挑战。
Transcatheter aortic valve implantation (TAVI) is increasingly being used in the management of severe aortic stenosis, mainly in older and/or medically compromised patients, due to its minimally invasive nature. As in any valve replacement procedure, endocarditis is a recognized complication, more so in TAVI patients, in whom comorbidities are highly prevalent. We report the
case of a 70-year-old male with a history of liver cirrhosis and a recent TAVI, who presented with recurrent fever and sustainedPediococcus pentosaceus bacteremia. The diagnosis of endocarditis was delayed, as the microorganism was initially discarded as a contaminant, given that Pediococci are rarely described as human pathogens. However, in cirrhotic patients, microbiota may cause intermittent bacteremia and thereby affect prosthetic valves. Transthoracic echocardiography was not helpful in validating the diagnosis, as is often the
case in TAVI patients. Transesophageal echocardiography was deemed perilous, due to esophageal varices complicating the underlying cirrhosis. Therefore, endocarditis diagnosis was based on sustained bacteremia and Duke\'s criteria, including the presence of high fever, a predisposing cardiac lesion, splenic infarction, and the exclusion of an alternative diagnosis. Moreover, cirrhosis enhanced the side effects of treatment and led to the need for regimen changes and prolonged hospitalization. Given the precariousness of the situation, confirmation of treatment success by 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) scan was sought. This is the first reported
case of Pediococcus TAVI endocarditis in a cirrhotic patient, highlighting the unique challenges in the diagnosis and management of TAVI endocarditis in patients with co-existing conditions.