日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 38(1): 38-47 (2022)
doi:10.9794/jspccs.38.38

症例報告Case Report

発熱前に弁破壊による急性僧帽弁閉鎖不全で発症した感染性心内膜炎の乳児例A Case of Infantile Infective Endocarditis Presenting Acute Mitral Regurgitation due to Valvular Destruction without Fever

1あかね会土谷総合病院小児科Department of Pediatrics, Tsuchiya General Hospital ◇ Hiroshima, Japan

2あかね会土谷総合病院心臓血管外科Department of Cardiovascular Surgery, Tsuchiya General Hospital ◇ Hiroshima, Japan

3国立循環器病研究センター病院小児循環器内科Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center ◇ Osaka, Japan

4国立循環器病研究センター病院病理部Department of Pathology, National Cerebral and Cardiovascular Center ◇ Osaka, Japan

受付日:2021年8月5日Received: August 5, 2021
受理日:2021年11月24日Accepted: November 24, 2021
発行日:2022年2月1日Published: February 1, 2022
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症例は生来健康の7か月女児.急性僧帽弁閉鎖不全による左心不全症状で第1病日に当院に搬送となり,第2病日に準緊急手術を行った.入院時から抗菌薬投与を開始し,入院8時間後から発熱を認めた.術中所見では僧帽弁両尖の破壊と後尖の穿孔を認め,僧帽弁の明らかな腱索断裂や疣腫は認めなかった.僧帽弁形成術が困難であったため,僧帽弁人工弁置換術を行った.血液,切除僧帽弁前尖の培養検査では細菌,真菌は陰性であったが,切除僧帽弁の病理組織像では好中球浸潤を認め,感染性心内膜炎と診断した.しかしその原因や起因菌の確定には至らなかった.乳児の急性僧帽弁閉鎖不全では,原因として感染性心内膜炎や特発性僧帽弁腱索断裂が挙げられる.本症例は発熱前に著明な弁破壊を来した感染性心内膜炎で,乳児特発性僧帽弁腱索断裂に類似して急激な臨床経過を辿った.生来健康な乳児の急性僧帽弁閉鎖不全についての治療や合併症はその原因によって異なるため,病理学的検討も含めて,注意して原因を確認しなければならない.

We present a case of a healthy 7-month-old female infant who developed sudden left heart failure due to acute mitral regurgitation (MR). She was rushed to our hospital on the day of onset and underwent semiemergency surgery the next day. Antimicrobial treatment was initiated upon admission, and pyrexia occurred 8 h later. At surgery, the anatomical findings included the destruction of both the anterior and posterior leaflets of the mitral valve, posterior mitral valve leaflet perforation, an undetected rupture of the chordae tendineae, and no vegetation on the mitral valve. Mitral valve replacement was performed because of the difficulty of mitral valve annuloplasty. A culture test of blood and resected anterior mitral valve demonstrated no bacterial or fungal infection, but histopathological analysis revealed polymorphonuclear cell infiltration of the resected mitral valve leaflet. The patient was diagnosed with infective endocarditis (IE) based on these findings; however, we were unable to determine the cause of infection or pathogenic bacteria. Acute MR in infants can be caused by IE and acute rupture of the chordae tendineae of the mitral valve (RCTMV). The current case of infantile IE started with acute MR due to significant valvular destruction, followed by pyrexia, and progressed quickly, similar to RCTMV in infants. Because the treatment and complications of acute MR in healthy infants are dependent on the cause, we must take special care to ascertain the cause along with histopathological analysis.

Key words: acute mitral regurgitation; infective endocarditis; mitral valve perforation; acute rupture of the chordae tendineae of the mitral valve in infants

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This page was last modified on 2022-05-26T09:37:14.000+09:00


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