Ruptured Sinus of Valsalva and Complete Atrioventricular Block Complicating Fulminant Course of Infective Endocarditis: A Case Report and Literature Review

細菌性心內膜炎併發主動脈竇破裂及完全房室傳導阻滯之急遽病程－一病例報告及文獻回顧

朱志生(Chih-Sheng Chu) ； 許超群(Chau-Chyun Sheu) ； 李坤泰(Kun-Tai Lee) ； 李碩粲(Shuo-Tsan Lee) ； 鄭凱鴻(Kai-Hung Cheng) ； 溫文才(Wen-Chol Voon) ； 許勝雄(Sheng-Hsiung Sheu) ； 賴文德(Wen-Ter Lai)

《The Kaohsiung Journal of Medical Sciences》 22卷8期 (2006/08) Pp. 398-403

摘要

病患感染細菌性心內膜炎可能會產生持續性高燒以及心臟衰竭，特別是在心臟瓣膜結構受到細菌破壞時。持續性的菌血症經常導致嚴重的敗血症，甚至惡化為敗血性休克。另外細菌贅生物所掉落的感染性血栓也可能導致全身性的血栓栓塞，進一步導致多重器官衰竭。曾有文獻報告過細菌性心內膜炎患者併發主動脈竇破裂或是完全房室傳導阻滯。然而這兩種嚴重的併發症同時出現在一個病人身上的情況則非常少見。本文描述一位54歲有酒精性肝硬化以及慢性腎衰竭的中年男性，罹患嚴重細菌性心內膜炎的臨床病程。同時併發的主動脈竇破裂與完全房室傳導阻滯更進一步的惡化敗血性休克以及誘發多重器官衰竭。

關鍵字

完全性房室傳導阻滯 ； 感染性心內膜炎 ； 多重器官衰竭 ； 主動脈竇破裂

並列摘要

Patients with infective endocarditis usually developed persistent fever and heart failure, especially when the valve structures are invaded and destroyed. Persistent bacteremia often leads to severe sepsis or overwhelming septic shock. Septic emboli from the vegetation will possibly result in systemic thromboembolism with multiple organ infarction. Patients with infective endocarditis have been reported to present with either ruptured sinus of Valsalva or complete atrioventricular block. However, both of these serious complications occurring in a single patient is rare. In this case report, we present a 54-year-old man with a previous history of alcoholic cirrhosis and chronic renal failure who suffered from a fulminant course of infective endocarditis. Simultaneously, ruptured sinus of Valsalva and complete atrioventricular block further complicated the preexisting septic shock and multiple organ failure.

並列關鍵字

complete atrioventricular block ； infective endocarditis ； multiple organ failure ； sinus of Valsalva rupture