先天性主动脉瓣病变感染性心内膜炎的瓣膜置换术

Valve replacement for endocarditis of congenital aortic valve anomalies

目的 探讨先天性主动脉瓣病变继发感染性心内膜炎 (CAVE)的外科治疗。方法1990年 5月 1999年 8月间共收治 5 2例CAVE。男 37例 ,女 15例 ,平均年龄 33 3岁。平均心胸比率为 0 5 8,左室舒张末径为 5 3～ 94mm (平均 6 8mm)。瓣膜病理类型以主动脉二瓣化畸形为主 ,占6 8%。术前血培养阳性率为 36 4 %。超声心动图检查结合术后病理检查是诊断CAVE的主要方法。瓣膜赘生物阳性率为 80 8%。心功能 (NYHA)Ⅲ级 2 8例 ,IV级 11例。全组病例均在体外循环下行主动脉瓣置换术 ,均选用机械瓣 (St Jude和Medtronic Hall占 6 0 % )。结果 早期死亡 2例 ,1例死于脑栓塞 ,1例死于 2次瓣膜置换术后瓣周漏严重心功能衰竭。 2例完全性房室传导阻滞均安装永久性心脏起搏器。出院检查体温均正常。平均左室舒张末径为 5 5mm (P <0 0 1)。随访 4 6例 ,平均随访 38个月。 1例术后发生瓣膜功能障碍。无晚期死亡和心内膜炎复发。结论 强调对CAVE早期治疗。术中彻底清除感染病灶 ,结合术后有效抗生素的应用 。

Objective To probe into the timing and method of surgical treatment of endocarditis of congenital aortic valve anomalies (CAVE) Methods Fifty two cases of CAVE from October 1990 to August 1999 were admitted in our hospital The mean age of the cases(37 male and 15 female)was 33 3±10 5 years The bicuspid aortic valve anomalies were dominant in pathological study (68%) The positive rate of blood culture was 36 4% in all the cases before operations The grade of cardiac function of the patients was in NYHA II(13 cases), III(28 cases) and IV(11 cases) All patients underwent the aortic valve replacement by extracorporeal circulation with mechanical prosthese Results There were two early deaths, one from postoperative cerebral embolism, the other from severe left heart failure and prosthesis regurgitation after repeated aortic valve replacement Complete AV block was found in 2 patients whom were performed pacemaker implantations During followed up of mean 38 months in 45 cases only one had valve dysfunction There were no late death and recurrence of CAVE Conclusion Surgical treatment for CAVE should be performed as early as possible Complete removal of the focus of infection in combination with effective postoperative antibiotics would be the key of preventing postoperative endocarditis recurrence