主动脉瓣心内膜炎伴瓣周脓肿的手术治疗

Surgical therapy for aortic valve endocarditis with paravalvular abscess

目的探讨手术治疗主动脉瓣心内膜炎合并瓣周脓肿的方法与疗效。方法1991年6月至2006年6月手术治疗21例主动脉瓣心内膜炎合并瓣周脓肿患者,其中男性14例、女性7例;平均年龄39.2岁（14-60岁）;自体主动脉瓣心内膜炎15例,人造心脏瓣膜心内膜炎6例。术中采用补片修补主动脉壁及瓣周缺损者9例,其中包括升主动脉左侧壁脓肿清除后形成瘘道,致主动脉与主肺动脉相通者3例;1例因主动脉壁及瓣周组织破坏严重难以用补片修补者,行Bentall手术,3例以自体心包或牛心包片重建主动脉瓣环,8例未作补片修补。全组行主动脉瓣置换术20例,Bentall术1例,所用21只人造心脏瓣膜均为机械瓣。结果2例（9.5%）人造瓣膜心内膜炎患者,术后早期死于多器官衰竭。长期存活19例,术后随访3月-15年（平均5.7年）,无晚期死亡,未见心内膜炎复发及瓣周漏。结论主动脉瓣心内膜炎合并瓣周脓肿手术治疗的原则为彻底清除感染病灶,妥善处理主动脉瓣病变,改善心脏等器官功能,应用有效的抗生素抗感染与预防再感染。

Objective To investigate the surgical procedure and efficacy for aortic valve endocarditis with paravalvular abscess. Methods From June 1991 to June 2006, 21 cases of aortic valve endocarditis with paravalvular abscess were retrospectively studied. Among them, 14 were male and 7 were female, and the mean age was 39.2 years （14 to 60 years）. The lesion of 15 cases were on native aortic valve and 6 were on prosthetic aortic valve. The aortic wall and peravalvular defect was repaired by patch in 9 cases, including 3 fistulous tracts between the aorta and main pulmonary artery. Bentall procedure was performed in one case because the aortic wall and paravalvular were infected so seriously that it could not be repaired by patch. The valvular annulus was rebuilt by autologous or bovine pericardium in another 3 cases. No patch repair was done in 8 cases. Aortic valve replacement was performed in 20 and Bentall procedure was performed in 1. All 21 artificial heart valves were mechanical. Results Two patients（9.5% ） with prosthetic valve endocarditis died of multiple organs failure earlier postoperatively. During 3 months to 15 years follow-up（ mean 5.7 years） , 19 patients survived without later mortality, recurrence of endocarditis and paravalvular leakage. Conclusion The surgical principle for aortic valve endocarditis with paravalvular abscess is to clear infectious sites thoroughly, handle aortic valve properly so as to improve heart function and prevent re-infection with effective antibiotics.