动脉导管未闭合并感染性心内膜炎的外科治疗

Surgical treatment of patent ductus arteriosus complicated with infective endocarditis

目的总结动脉导管未闭(PDA)合并感染性心内膜炎(IE)外科诊疗的经验。方法32例患者术前均行超声心动图检查(UCG),均在体外循环下进行畸形矫正和赘生物清除。其中18例单纯PDA采用直视缝合法,同期行主动脉瓣置换术6例、室缺修补术和房缺修补术各4例。结果UCG发现赘生物27例,阳性率84.4%,术后病检证实IE改变。1例急诊行PDA直视缝合术及主动脉瓣置换术患者术后因顽固低心排死亡,其余患者均痊愈出院。随访4～152个月,无晚期死亡和IE复发。结论UCG在诊断中有重要作用,正确把握手术时机对治疗效果至关重要。

Objective To review the surgical experience of 32 patients with patent duetus arteriosus complicated with infective endoearditis. Methods Retrospective study was done. All the cases underwent preoperative UCG and cardiac operations with extraeorporeal circulation. During the operations,infected tissues were excised, valvular dyfunetions were corrected, and congenital cardiac defects were treated. Results Vegetations were observed in 27 eases with the positive rate being 84.4 %. There was 1 postoperative death because of stubborn eardial failure,and the other patients got full recovery. All eases were followed up with no recurrent IE and no death. Conclusion Eehocardiography is valuable tool in diagnosis. Urgent surgical intervention is effective for patent ductus arteriosus complicated with infective endocarditis, and the timing of operation plays an important role in the therapeutic efficacy.