感染性心内膜炎瓣膜损害的外科治疗

目的 总结43例感染性心内膜炎瓣膜损害的外科治疗经验。方法 43例中累及主动脉瓣35例次 ,二尖瓣16例次。术前心功能Ⅱ级11例 ,Ⅲ级23例 ,Ⅳ级9例。均在体外循环下清除赘生物、感染瓣膜及组织 ,选用机械瓣行AVR26例 ,AVR +MVR8例 ,MVR8例 ,AVR +TVR1例 ,合并畸形同期矫治。其中3例紧急手术 ,28例亚急症手术。 结果 本组无手术死亡 ,术后随访率100% ,平均随访 (27.4±22.1)个月 ,心内膜炎复发率4.7 % ,晚期死亡率1.75%病人年。结论 感染性心内膜炎瓣膜损害应积极手术治疗。只要术中彻底清除感染组织 ,选用人工机械瓣膜替换 ,合理应用抗菌素 。

Objective To review the experience of surgical treatment of valve lesions caused by infective endocarditis. Methods 29 male and 14 female patients (mean age 39 years) with valve lesions caused by infective endocarditis received surgical intervention under cardiopulmonary bypass. The aortic valve was involved in 26 patients, the mitral valve in 8 patients, both aortic and mitral valves in 8 patients, and both aortic and tricuspid valves in 1 patient. Preoperative cardiac functional class (NYHA, New York Heart Association) of 11 patient was Ⅱ, 23 patients was Ⅲ and 9 patients was Ⅳ . Emergency operations of 3 patients and urgent operations of 28 patients were performed. Vegetations, infected valves and cardiac tissue were excised and debrided. All patients underwent valve replacement with mechanical prosthesis. Results There was no operative death. Follow-up was 100% completed with a average follow-up period of 27.4±22.1 months. There were two late death due to recurrence of infective endocarditis. The recurrent rate of infective endocarditis was 4.7%, and the late mortality was 1.75% patient-year. At the last follow-up, all survival patients were in NYHA class Ⅰor Ⅱ. Conclusion Early surgical intervention is recommended in patients with valve lesions caused by infective endocarditis. The indications of emergency and urgent operation are rapidly progressive cardiac deterioration, vegetation seen on echocardiography and uncontrolled sepsis. Outcome of operation is good if operative method is correct and the usage of antibiotic is rational. The recurrent rate of infective endocarditis is low with implantation of mechanical prosthesis.