[Mycotic aneurysm of the sinus of Valsalva and complete atrioventricular block complicating infectious endocarditis with aortic regurgitation: a case report].

Journal of cardiology. Supplement Pub Date : 1991-01-01
M Abe, M Hamada, Y Fujiwara, Y Shigematsu, T Sumimoto, K Hiwada
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Abstract

A patient with a mycotic aneurysm of the sinus of Valsalva and heart block secondary to infectious endocarditis was described. This 46-year-old man was admitted to our hospital on May 9, 1990, because of fever and progressive general malaise after extraction of a tooth. Physical examination on admission revealed blood pressure of 98/62 mmHg, pulse rate 96 per min, temperature 37.7 degrees C and respiration 35 per min. Auscultation of the heart revealed a grade 3/6 systolic murmur and a grade 2/6 diastolic murmur at the third left intercostal space. Chest radiograph showed mild cardiomegaly with moderate lung congestion. Electrocardiography revealed the first grade atrioventricular block. Echocardiography demonstrated vegetations on the aortic valve, and perforation of the non-coronary sinus of Valsalva. The prolapsed non-coronary sinus of Valsalva extended into the right atrium. Doppler echocardiography revealed a severe aortic regurgitant jet in the diastolic phase. We diagnosed the patient as having aortic regurgitation with a mycotic aneurysm of the non-coronary sinus of Valsalva due to infectious endocarditis. His condition remained severely ill despite intensive medical treatment. On May 14, 1990, aortic valve replacement and excision of the mycotic aneurysm were performed. The commissural portions of the aortic cusps were heavily thickened and calcified. The mycotic aneurysm was very fragile. During manipulating the mycotic aneurysm, the sinus accidentally perforated into the right atrium. The cardioaortic fistula was closed with a goretex patch. A demand pacemaker was implanted because of postoperative complete atrioventricular block.(ABSTRACT TRUNCATED AT 250 WORDS)

【Valsalva窦真菌性动脉瘤合并完全性房室传导阻滞并发感染性心内膜炎并主动脉瓣反流1例】。
一个病人与真菌性动脉瘤窦Valsalva和心脏传导阻滞继发于感染性心内膜炎。患者46岁,1990年5月9日因拔牙后发热及进行性全身不适入住我院。入院时体检血压98/62 mmHg,脉搏96次/分,体温37.7℃,呼吸35次/分。心脏听诊示左肋间隙3/6级收缩期杂音和2/6级舒张期杂音。胸片显示轻度心脏肥大伴中度肺充血。心电图显示为一级房室传导阻滞。超声心动图显示主动脉瓣赘生物和Valsalva非冠状动脉窦穿孔。Valsalva非冠状动脉窦的脱垂延伸至右心房。多普勒超声心动图显示在舒张期有严重的主动脉反流。我们诊断该患者为感染性心内膜炎引起的主动脉反流合并非冠状窦真菌性动脉瘤。尽管进行了密集的治疗,他的病情仍然很严重。1990年5月14日,进行了主动脉瓣置换术和真菌性动脉瘤切除术。主动脉尖的接合部分严重增厚和钙化。霉菌性动脉瘤非常脆弱。在操作真菌性动脉瘤时,窦意外穿孔进入右心房。心主动脉瘘用气管补片缝合。术后因完全性房室传导阻滞植入需点起搏器。(摘要删节250字)
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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