背景:感染性心内膜炎(IE)是2019年冠状病毒病(COVID-19)患者的一种罕见心血管并发症。COVID-19后的IE也可能并发急性呼吸窘迫综合征(ARDS);然而,这类病例的治疗指南不清楚。这里,我们报告了1例使用静脉-静脉体外膜氧合(V-VECMO)对COVID-19IE后并发ARDS进行围手术期处理的病例.
方法:患者是一名40岁女性,在COVID-19发病第18天入院,接受氧疗,remdesivir,还有地塞米松.病人的病情得到改善;然而,在住院的第24天,患者出现低氧血症,并因呼吸衰竭入住重症监护病房(ICU).血培养显示纹状体棒状杆菌,经食道超声心动图显示主动脉瓣和二尖瓣上有植被。瓣膜破坏轻微,呼吸衰竭的原因被认为是ARDS。尽管持续的抗菌治疗,ARDS没有改善患者的病情,和阀门破坏进展;因此,手术治疗安排在入住ICU的第13天.在与团队进行术前咨询后,决定在患者脱离CPB后启动V-VECMO,担心手术后呼吸状态进一步恶化。患者返回ICU,过渡到V-VECMO,她的血液循环保持稳定。患者在术后第33天脱离V-VECMO,并在术后第47天从ICU出院。
结论:在COVID-19后,IE患者可能发生ARDS。由于对肺损伤进一步恶化的担忧,应综合考虑手术时机。术前,临床医生应讨论围手术期ECMO的引入和配置。
BACKGROUND: Infective endocarditis (IE) is a rare cardiovascular complication in patients with coronavirus disease 2019 (COVID-19). IE after COVID-19 can also be complicated by acute respiratory distress syndrome (ARDS); however, the guidelines for the treatment of such cases are not clear. Here, we report a case of perioperative management of post-COVID-19 IE with ARDS using veno-venous extracorporeal membrane oxygenation (V-V ECMO).
METHODS: The patient was a 40-year-old woman who was admitted on day 18 of COVID-19 onset and was administered oxygen therapy, remdesivir, and dexamethasone. The patient\'s condition improved; however, on day 24 of hospitalization, the patient developed hypoxemia and was admitted to the intensive care unit (ICU) due to respiratory failure. Blood culture revealed Corynebacterium striatum, and transesophageal echocardiography revealed vegetation on the aortic and mitral valves. Valve destruction was mild, and the cause of respiratory failure was thought to be ARDS. Despite continued antimicrobial therapy, ARDS did not improve the patient\'s condition, and valve destruction progressed; therefore, surgical treatment was scheduled on day 13 of ICU admission. After preoperative consultation with the team, a decision was made to initiate V-V ECMO after the patient was weaned from CPB, with concerns about further worsening of her respiratory status after surgery. The patient returned to the ICU with transition to V-V ECMO, and her circulation remained stable. The patient was weaned off V-V ECMO on postoperative day 33 and discharged from the ICU on postoperative day 47.
CONCLUSIONS: ARDS may occur in patients with IE after COVID-19. Owing to concerns about further exacerbation of pulmonary damage, the timing of surgery should be comprehensively considered. Preoperatively, clinicians should discuss perioperative ECMO introduction and configuration.