右心瓣膜感染性心内膜炎的外科治疗

Surgical intervention of right-sided infective endocarditis

目的 总结右心系统瓣膜心内膜炎的特点和手术处理经验。方法 回顾性分析右心系统瓣膜感染性心内膜炎 17例 ,其侵犯三尖瓣 6例、肺动脉瓣 4例 ,同时侵犯三尖瓣 +肺动脉瓣 3例 ,肺动脉瓣 +主动脉瓣 3例 ,主动脉瓣、二尖瓣、三尖瓣与肺动脉瓣同时受累 1例。合并心脏畸形 14例 ,室间隔缺损修补术后、主动脉窦瘤破裂修补术后、起搏器安置术后各 1例。施行三尖瓣瓣膜游离缘或瓣膜赘生物切除直接缝合 5例、三尖瓣瓣膜赘生物切除用自体心包片修补 2例、部分瓣叶和瓣下结构切除缝合瓣叶并行人工腱索成形术 1例 ,施行三尖瓣置换术 2例 ;单纯行肺动脉瓣瓣叶赘生物切除 4例 ,部分肺动脉瓣切除用自体心包片瓣叶成形术 6例 ,切除肺动脉瓣用自体心包瓣置换 1例。结果术后早期死亡 2例 ,病死率为 12 % ,术后早期并发急性肾功能不全 3例 ,肝功能不全 1例。术后随访 5个月～ 18年 ,平均随访时间 5 8年 ,失访 2例 ,发生室缺残余漏 1例 ,复发主动脉瓣心内膜炎 1例。结论 右心系统心内膜炎选择手术治疗不仅可清除瓣膜和缺损周围的赘生物 ,而且可修复瓣膜和心脏缺损 ,以达到纠正异常的血流动力学和防止心内膜炎复发的目的。

Objective To summarize the experience of surgical treatment of right sided infective endocarditis. Methods In this series of 17 cases, 6 patients have involvement of tricuspid valve, 4 pulmonary valve, 3 tricuspid valve and pulmonary valve, 3 pulmonary valve and aortic valve, 1 tricuspid valve, pulmonary valve, aortic valve and mitral valve. Congenital cardiac lesions were found in 14 cases. Tricuspid valve repair or reconstruction was performed in 8 cases, tricuspid valve replacement in 2, pulmonary valve repair in 10, pulmonary valve replacement by autologous pericardium in 1. Results There were 2 early postoperative deaths giving an overall hospital mortality of 12%. Follow up of 5 months to 18 years, 1 had recurrent aortic valve endocarditis and 1 residual VSD. Conclusion Surgical therapy for right sided infective endocarditis can completely eradicate lesions and correct the associated hemodynamic derangement.