Sağ Ventrikül Çıkış Yolu ve Triküspit Kapak Endokarditi Yönetimi
Özet
Mural endokardit, kapak tutulumu ile birlikte görülen oldukça nadir bir klinik durumdur. Bu olguda, intravenöz madde kullanım öyküsü bulunan, kanlı balgam ve ateş şikayetleri ile başvuran 35 yaşında erkek bir hasta sunulmaktadır. Enfektif endokarditin (EE) tanısında ekokardiyografi temel bir rol oynamakta olup, hastamızda hem kapak düzeyinde hem de sağ ventrikül çıkış yolunda endokardit bulguları saptanmıştır. Alınan kan kültürlerinde, sağ kalp yerleşimli endokarditin en sık etkeni olan metisiline duyarlı Staphylococcus aureus (MSSA) izole edilmiştir. Sağ kalp endokarditi tüm endokardit olguları arasında nadir görülürken, mural endokardit bu grubun içinde daha da seyrek rastlanan bir tablodur. Bu olgu aracılığıyla, söz konusu nadir klinik durumun tanı süreci, olası komplikasyonları ve tedavi yaklaşımı ele alınmıştır.
Mural endocarditis is a very rare clinical condition that occurs in conjunction with valvular involvement. In this case, we present a 35-year-old male patient with a history of intravenous drug use who was admitted with complaints of hemoptysis and fever. Echocardiography plays a fundamental role in the diagnosis of infective endocarditis (IE), and in our patient, endocarditis findings were detected both at the valvular level and in the right ventricular outflow tract. Blood cultures revealed methicillin-sensitive Staphylococcus aureus (MSSA), which is the most common causative pathogen of right-sided endocarditis. While right-sided endocarditis is relatively uncommon among all endocarditis cases, mural endocarditis is an even rarer entity within this group. Through this case, the diagnostic process, potential complications, and treatment approach of this rare clinical condition are discussed.
Referanslar
Fleischauer AT, Ruhl L, Rhea S, Barnes E. Hospitalizations for endocarditis and associated health care costs among persons with diagnosed drug dependence - North Carolina, 2010–2015. MMWR Morb Mortal Wkly Rep 2017;66:569–73. doi:10.15585/mmwr.mm6622a1.
Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015;65:2070–6. doi:10. 1016/j.jacc.2015.03.518.
Chan P, Ogilby JD, Segal B. Tricuspid valve endocarditis. Am Heart J 1989;117:1140–6. doi:10.1016/0002-8703(89)90874-0.
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century. Arch Intern Med 2009;169:463. doi:10.1001/archinternmed.2008.603.
Pellicelli AM, Pino P, Terranova A, et al. Eustachian valve endocarditis: a rare localization of right side endocarditis. A case report and review of the literature. Cardiovasc Ultrasound. 2005;3:30.
Mathew J, Addai T, Anand A, et al. Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. Arch Intern Med. 1995;155:1641–1648.
Zijlstra F, Fioretti P, Roelandt JR. Echocardiographic demonstration of free wall vegetative endocarditis complicated by a pulmonary embolism in a patient with ventricular septal defect. Br Heart J. 1986;55:497–499.
Akinosoglou K, Apostolakis E, Marangos M, Pasvol G. Native valve right sided infective endocarditis. Eur J Intern Med. 2013;24:510–519
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, et al.; Group ESCSD. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–3128
Reisberg BE. Infective endocarditis in the narcotic addict. Prog Cardiovasc Dis. 1979;22:193–204.
Yuan SM. Right-sided infective endocarditis: recent epidemiologic changes. Int J Clin Exp Med. 2014;7:199–218
Galili Y, Lytle M, Carlan S, Madruga M. Bilateral pneumothoraces: a rare complication of septic pulmonary emboli in intravenous drug abusers. Am J Case Rep. 2018;19:829–832.
