心脏人工瓣膜术后真菌性心内膜炎2例报告及治疗策略文献综述

目的探讨心脏人工瓣膜置换术后真菌性心内膜炎的治疗策略。方法对2例心脏人工瓣膜术后并发严重真菌感染病例进行回顾性分析,并进行相关文献复习。结果 2例患者术后并发真菌性心内膜炎,均影响瓣膜功能,术后均反复住院,病例一,心脏术后45 d出现发热,返院复诊,予以急诊在体外循环下行再次二尖瓣置换术,术后赘生物培养为黄曲霉菌;病例二,心脏术后5个月在体外循环下行主动脉壁赘生物清除,术后赘生物病理提示毛霉菌。2例患者均及时手术清除感染灶并进行规范抗真菌治疗,曲霉菌感染患者抢救无效,毛霉菌感染患者治愈,后者抗真菌治疗强度更大。结论心脏人工瓣膜置换术后并发真菌性心内膜炎,预防是关键,治疗要及时、有效,抗真菌药物必须足量、足疗程。

Fungal endocarditis after heart prosthetic valve surgery: two case report and literature review on treatment strategies

ObjectiveTo evaluate treatment strategies for fungal endocarditis after heart prosthetic valve surgery.MethodsTwo cases of severe fungal infection after heart prosthetic valves surgery were analyzed retrospectively, related literatures were reviewed.ResultsTwo patients had fungal endocarditis after surgery, the valve function was affected, patients were hospitalized repeatedly after surgery. In case 1, fever occurred 45 days after cardiac surgery and patient was returned to the hospital for re examination, emergency mitral valve replacement was performed under cardiopulmonary bypass, the postoperative vegetation culture suggested Aspergillus flavus. In case 2, the aortic wall vegetation was removed 5 months after heart surgery under cardiopulmonary bypass, pathology of postoperative vegetation suggested mucor. Two patients were promptly removed infection foci through surgery and treated with standard antifungal agents, patient with Aspergillus infection died after rescue, and patient with mucor infection was cured, the latter was more powerful in antifungal therapy.ConclusionPrevention is the key to fungal endocarditis after heart prosthetic valve surgery, treatment should be prompt and effective, antifungal agents should be given in sufficient dose and course.