2023-09-13 03:35:13
CNEWS Convergence News Network reporter Chen Junkai/Reporting from Taipei
A small breach may lead to a big crisis! The 59-year-old Mr. Cai often suffers from mouth ulcers. Sometimes he bites the skin while eating, and sometimes it is small ulcers or blood blisters for unknown reasons. Recently, he developed oral ulcers, but he didn’t take it seriously. Unexpectedly, he later developed a fever that was so serious that he had to insert it. After being admitted to the intensive care unit, it was discovered that he had infective endocarditis combined with mitral regurgitation caused by the oral bacteria “Streptococcus sanguis”. Finally, his life was saved by replacing the artificial valve.
Mr. Cai was initially hospitalized for two days due to suspected pneumonia. After he was discharged, he still had an intermittent fever. Finally, he was sent to the emergency room because of sudden chest tightness and difficulty breathing.
Luo Chongyou, a cardiovascular surgeon at Taipei Tzu Chi Hospital, said that the current examination found that Mr. Tsai’s blood oxygen concentration was 92% (normal is 95%), and that he had bilateral lung infiltration and an extremely high inflammation index. He was intubated and admitted to the intensive care unit for treatment. Further ultrasound examination revealed severe mitral valve regurgitation and multiple vegetations. It was then discovered that the culprit was infective endocarditis combined with mitral valve regurgitation caused by bacteria.
Foreign studies have pointed out that the annual incidence of infective endocarditis is regarding 3 to 10 per 100,000 people, and 20% of it is caused by viridans streptococci in the oral cavity, of which Streptococcus sanguis is one. .
Luo Chongyou said that the left ventricle is the most important structure in the heart for outputting blood. When the left ventricle contracts, the mitral valve closes, allowing the left ventricle to infuse blood to the body’s large blood vessels and supply tissues throughout the body. Counterflow refers to when the left ventricle contracts. The cusp valve cannot close completely, and some blood will flow back into the left atrium. Mitral regurgitation can lead to a significant decrease in cardiac output, which can lead to severe cardiogenic shock and multiple organ failure. The backward blood can accumulate in the lungs, causing severe pulmonary edema, which is life-threatening.
If it is just simple mitral regurgitation, there is a chance that it can be treated with minimally invasive surgery. However, Mr. Cai’s condition is not simple. Luo Chongyou said that because his mitral valve not only has reflux, but also has a large damage of regarding 1 cm, and there are even more signs of damage around it. Many bacteria infected the proliferated vegetations, which limited the effectiveness of antibiotic treatment. The medical team decided to treat the patient with traditional thoracotomy. Two days following the operation, the pulmonary edema improved significantly. After continuous antibiotic treatment for 6 weeks, he recovered and was discharged.
Luo Chongyou reminded that any bacteria in the blood have the risk of infecting the heart. Although the human immune system will try to kill the bacteria at the beginning of the infection, if the number of bacteria is too large, it will be difficult to cure the proliferation of vegetations. Therefore, people must pay attention to oral health care, brush their teeth frequently, and use mouthwash frequently to maintain oral health. If there are ulcers or inflammation, seek medical treatment.
Photo source: Provided by Taipei Tzu Chi Hospital
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