Preoperative Demonstration of Aortocardiac Fistula Caused by Aortic Valve Endocarditis Using Real-time Three-dimensional Echocardiography-A Case Report

三維實時超音波診斷主動脈瓣心內膜炎併發主動脈右心房瘻管－病例報告

王禎煜(Jen-Yu Wang) ； 蔡天堯(Tien-Yao Tsai) ； 許榮彬(Ron-Bin Hsu) ； 林隆君(Lung-Chun Lin) ； 吳造中(Chau-Chung Wu)

《Acta Cardiologica Sinica》 21卷2期 (2005/06) Pp. 116-120

摘要

儘管診斷與治療方法日新月異，感染性心內膜炎仍造成相當的罹病率與死亡率。發生於主動脈瓣的感染性心內膜炎，可侵犯瓣輪部位，造成嚴重的瓣膜逆流，併發心臟傳導異常及較少見的心臟瘻管。我們報告一位罹患Staphylococcus capitis感染性主動脈瓣心內膜炎的患者，經心臟超音波診斷出嚴重的主動脈瓣逆流併發侵犯瓣輪部，進而形成主動脈和右心房間的瘻管。雖然起初血行動力學穩定，完成抗生素四週的療程。但於瓣膜置換手術前一日，因突發加劇的完全主動脈瓣逆流造成急性心衰竭，必須進行緊急手術，幸而術前正確的三維實時心臟超音波診斷，提供施術者完整的病灶及併發症解剖資訊，使得緊急外科手術治療順利完成。

關鍵字

感染性心內膜炎 ； 主動脈右心房瘻管 ； 三維實時心臟超音波

並列摘要

Despite advances in diagnostic modality and treatment, infective endocarditis is still a life-threatening disease with significant morbidity and mortality. Endocarditis of native aortic valve may invade the perivalvular tissue, causing a severe valvular regurgitation, conduction disturbances, and less commonly, the intracardiac fistula. We here report a 52-year-old woman with infective endocarditis caused by Staphylococcus capitis. Echocardiographic examination revealed severely destructed aortic valve with perivalvular invasion, resulting in an aortocardiac fistula into the right atrium. The initial hemodynamic status of the patient was so stable that a full-course of antibiotic treatment for 4 weeks could be completed. However, just one day before the scheduled operation, sudden onset of free aortic regurgitation resulted in an acute decompensated heart failure and prompted the patient to an emergent operation. Accurate preoperative diagnosis by 3D-echocardiography made the emergent surgical intervention smooth and successful.

並列關鍵字

Infective endocarditis ； Aortocardiac fistula ； 3D echocardiography