感染性主动脉瓣心内膜炎的外科治疗

Surgical Treatment of Infective Aortic Valve Endocarditis

目的：报告感染性主动脉瓣心内膜炎的外科治疗经验。方法：７６例感染性主动脉瓣心内膜炎患者，男５８例，女１８例，平均年龄３７．８±１１．３（１２～６０）岁。其中动脉血培养阳性４１例，阴性３５例。２７例（急性活动期）因急性心力衰竭或严重败血症等并发症而急症手术，４９例（慢性静止期）在抗生素治疗６周后择期手术。本组７６例患者行主动脉瓣替换术７４例；应用带瓣管道行主动脉根部、主动脉瓣替换和冠状动脉移植术２例。同期处理动脉导管未闭３例、佛氏窦瘤破裂＋心室间隔缺损６例、心室间隔缺损３例、二尖瓣关闭不全１１例和三尖瓣关闭不全５例。结果：７６例患者术后早期死亡５例（６．６％）：急性活动期２例，慢性静止期３例。术后平均随访４．１５年（１０个月～１０年），晚期死亡４例，其中２例死于人工瓣膜性心内膜炎。结论：感染性主动脉瓣心内膜炎手术时机的掌握对治疗效果至关重要，急症手术并不增加手术死亡率。

? Objective:To report the experiences of surgical treatment of infective aortic valve endocarditis. Methods:There were 76 patients with endocarditis with blood culturepositive in 41 patients and culturenegative in 35.The mean age of the 58 male and 18 female was 378±113 years (rang 12 to 60 years).They were divided into two categories:acute and active group(n=27) in which emergent surgery was performed due to uncontrolled acute heart failure and severe sepsis,and chronic and inactive group(n=49) in which selective surgery was done after antibiotic treatment for 6 weeks.Aortic valve replacement was performed with mechanical prostheses in 74 patients,and Bentall procedure in 2.Associated cardiac lesions,including patent ductus arteriosus in 3,ventricular septal defect in 9,rupture of Valsalvas sinus in 6,mitral insufficiency in 11 and tricuspid valve insufficiency in 5 were managed simultaneously. Results:A total of 5 early deaths:2 in emergency and 3 in selective operation,yielded an overall operative mortality of 66%.During the followup of 10 months to 10 years with a mean of 415 years,there were 4 late death:2 of prosthetic valve endocarditis,2 of other causes. Conclusion:Surgical intervention is an effective treatment method for infective aortic valve endocarditis.The timing of surgery plays an important role in the operative results.Emergent surgery does not increase the operative mortality.