原发性感染性心内膜炎主动脉瓣损害的手术治疗

Operation intervention of primary aortic valve infective endocarditis

目的探讨有主动脉瓣损害的原发性感染性心内膜炎的手术时机。方法2002年1月至2004年12月对18例原发性感染性心内膜炎患者大剂量静脉应用抗生素,14例患者两周内体温正常后4～6周内限期手术。4例患者感染未能控制,心衰加重,2周内带菌手术。手术方式为在体外循环(CPB)下清除所有感染病灶,重建瓣膜功能,矫治先天畸形。结果18例病人无手术死亡及术后早期死亡,随访1～24个月,无复发,心功能Ⅰ～Ⅱ级。结论感染性心内膜炎有主动脉瓣损害时,药物治疗往往难以控制病情。必要的术前准备,掌握好手术时机,才能取得满意疗效。

Objective To study the appropriate timing of operation on thos e patients with primary aortic valve infective endocarditis. Method From Jan uary 2002 to December 2004, 18 patients with primary aortic valve infective endo carditis were treated with high-dose of antibiotic. In 4~6 weeks, the operation was treated in 14 cases whose temperature resume normal after two weeks medical therapy. Emergency Operation is performed in 4 cases with infection no control a nd combined with cardiac dysfunction in two weeks. The operation technique inclu ding removing infective tissue,reconstructing the fuction of valve and remeding congenital malformation of heart. Results All patients were alive during ope ration and there were no early postoperative deaths. Follow-up of 1 to 24 months , no case recurrent,cardiac functionⅠ～Ⅱ stage. Conclusions The therapeuti c effectiveness is worse in those patients with primary aortic valve infective e ndocarditis treated with medical therapy. Essential perioperative management and appropriate timing operation are the main determinates in the patients with pri mary aortic valve infective endocarditis