Komplette Okklusion der Arteria radialis durch einen kardiogenen Embolus bei infektiöser Endokarditis

Zusammenfassung

Wir präsentieren den Fall einer septischen Thrombosierung der rechtsseitigen Arteria radialis durch einen kardiogenen Embolus auf Grundlager einer infektiösen Endokarditis. Nach initialem Verdacht einer beugeseitigen Unterarmphlegmone bei bestehender Tenosynovitis zeigte sich intraoperativ eine langstreckige Thrombosierung der Arteria radialis. Wir führten die Resektion des thrombosierten Gefäßabschnittes sowie die Rekonstruktion mittels Veneninterponat durch. Im Rahmen der Fokussuche fanden sich echokardiografisch Vegetationen am vorderen Mitralklappensegel. Im Zuge dessen erfolgte die operative Mitralklappensegelrekonstruktion mittels Mitralklappenanuloplastik.

Abstract

We present a case of septic embolization of the right radial artery by a cardiogenic embolus resulting from infective endocarditis. After the first suspicion of a palmar forearm phlegmon due to tenosynovitis was voiced, surgery revealed a long-segment occlusion of the radial artery. We resected the thrombosed part of the artery and reconstructed the latter with a vein interposition graft. Further diagnostic evaluation by echocardiography revealed vegetations on the anterior mitral leaflet. Reconstruction of the mitral valve was performed by annuloplasty.

Schlüsselwörter

Phlegmone - Revaskularisation - Arterien - Perfusion - septischer Embolus

Key words

Phlegmon - artery - septic embolization

Publication History

Received: 14 January 2021

Accepted: 21 December 2021

Article published online:
13 April 2022

• Literatur

• 1 Benito N, Miro JM, de Lazzari E. et al. Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med 2009; 150: 586-594
• 2 Chu VH, Sexton DJ, Cabell CH. et al. Repeat infective endocarditis: differentiating relapse from reinfection. Clin Infect Dis 2005; 41: 406-409
• 3 Schünemann S, Werner GS, Schulz R. et al. Embolische Komplikationen bei bakterieller Endokarditis. Clinical Research in Cardiology 1997; 86: 1017-1025
• 4 Di Salvo G, Habib G, Pergola V. et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001; 37: 1069-1076
• 5 Syrjänen J. Central nervous system complications in patients with bacteremia. Scand J Infect Dis 1989; 21 (03) 285-296
• 6 Cabell CH, Pond KK, Peterson GE. et al. The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J 2001; 142: 75-80
• 7 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). European Heart Journal 2015; 36: 3075-3128
• 8 Thuny F, Di Salvo G, Belliard O. et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005; 112: 69-75
• 9 Mügge A, Daniel WG, Frank G. et al. Echocardiography in infective endocarditis: Reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol 1989; 14 (03) 631-638
• 10 Tischler MD, Vaitkus PT. The ability of vegetation size on echocardiography to predict clinical complications: a meta-analysis. J Am Soc Echocardiogr 1997; 10: 562-568
• 11 Girsch W, Knabl J, Rab M. Revaskularisation und Defektdeckung der Hand: Spezielle Einsatzmöglichkeiten des Radialis-Unterarmlappens [Revascularization and defect coverage of the hand: special applications of the radialis forearm flap]. Handchir Mikrochir Plast Chir 2001; 33 (02) 89-94