高橋 みさ子¹, 高橋 経寛¹, 佐竹 恒雄¹, 金谷 透²

Misako TAKAHASHI¹, Tsunehiro TAKAHASHI¹, Tsuneo SATAKE¹, Tohru KANAYA²

¹公立学校共済組合東北中央病院臨床検査科生理, ²公立学校共済組合東北中央病院循環器内科

¹Department of Clinical Laboratory, Tohoku Central Hospital of Japan Mutual Aid Association of Public School Teachers, ²Department of Cardiovascular Medicine, Tohoku Central Hospital of Japan Mutual Aid Association of Public School Teachers

キーワード : Vegetation, Intracardiac pacing lead, 2-dimensional echocardiography, Infective endocarditis, Bacillus cereus

A case of intracardiac pacing lead and tricuspid valve vegetation with complicated infective endocarditis was examined through two-dimensional echocardiography and two-dimensional color Doppler flow mapping.
A 74-year-old man was admitted to our hospital with a high fever and general fatigue 4 months ago. On admission, a grade-4 pansystolic cardiac murmur was audible at the base. He had received a VVI pacer 5 years before. His WBC and BSR were elevated and his CRP was positive. The blood culture in the patient was also positive, and gram-positive rods and Bacillus cereus were observed through our laboratory tests. The endocarditis caused by this bacteria is rare. We suspected infective endocarditits with the vegetation in the tricuspid valve and intracardiac pacing lead. The preoperative two-dimensional color Doppler flow mapping also indicated that tricuspid regurgitation flow avolded vegetation around the intracardiac pacing lead.
We concluded that a careful two-dimensional echocardiography was useful as a diagnostic method to quickly detect vegetation in the infective endocarditis and to determine the need and timing for cardiac surgical treatment.