68例合并感染性心内膜炎的主动脉瓣二瓣化畸形患者的临床特征分析

Clinical Characteristics of 68 Patients with Bicuspid Aortic Valves Combined Infective Endocarditis

目的描述合并感染性心内膜炎(infective endocarditis,IE)的主动脉瓣二瓣化畸形(bicuspid aortic valve,BAV)成年患者的临床特征和院内结局。方法本研究收集2013年1月至2018年12月在阜外医院住院诊治的68例合并IE的BAV患者和204例单纯BAV成年患者的临床资料,回顾性分析并比较两组患者的临床特征、影像学表现、治疗方式和院内结局,描述合并IE组患者的致病菌谱。结果与单纯BAV患者相比,合并IE的BAV患者平均年龄更低【(38±11)岁vs(49±13)岁,P<0.001】,男性占比更高(88.2%vs75.5%,P=0.026),更少合并高血压(14.7%vs 32.8%,P=0.004)、冠心病(4.4%vs15.7%,P=0.016)、糖尿病(2.9%vs 10.8%,P=0.048),临床症状更明显、心功能相对更差。心脏超声检查结果提示,合并IE的BAV患者平均左室舒张末期内径、平均主动脉瓣环内径均大于单纯BAV患者【(65.3±8.8)mm vs(56.4±11.4)mm,P<0.001;(25.4±3.3)mm vs(24.0±3.3)mm,P=0.002】;合并IE的BAV患者主动脉瓣有中大量反流表现的患者明显多于单纯BAV组(91.2%vs 49.0%,P<0.001),而有主动脉瓣中重度狭窄表现的患者明显少于单纯BAV患者(16.2%vs 50.0%,P<0.001)。血和瓣膜赘生物病原学培养发现,与导致单纯IE的病原菌相同,链球菌属是合并IE的BAV患者的主要致病菌。合并IE的BAV患者中64例(94.1%)接受外科手术,无死亡和二次手术发生,4例患者接受内科治疗,其中1例(1.5%)患者因多器官功能衰竭死亡。单纯BAV患者中192例(94.1%)进行外科治疗,其中2例(1%)发生院内死亡,6例(3.1%)因出血、瓣周漏等原因进行二次开胸手术。两组患者院内死亡率及再次手术率无统计学差异。结论合并IE的BAV患者发病年龄低,男性多见,合并基础疾病少见,主动脉瓣瓣以关闭不全为主。目前合并IE的BAV患者的主要治疗方式为外科手术,其院内结局与单纯BAV相比无明显差异。

Objective To investigate the clinical characteristics and in-hospital outcomes of bicuspid aortic valves(BAV)combined infective endocarditis(IE),compared with patients with isolated BAV.Methods The retrospective study incorporated 68 BAV with IE and 204 isolated BAV adult patients hospitalized in Fuwai Hospital from 2013 to 2018.The clinical manifestations,imaging features,etiology characteristics,treatments and in-hospital outcomes of the two groups were comprehensively reviewed and compared.Results BAV with IE patients were younger([38±11]years vs[49±13]years,P<0.001),had fewer comorbidities including hypertension,coronary heart disease and diabetes than isolated BAV patients.The symptoms were more serious and heart function was relatively worse than isolated BAV patients.Male predominance was also observed.Echocardiography showed that the average of left ventricular diastolic dimension,aortic annulus diameter of BAV with IE patients were larger compared with isolated BAV patients([65.3±8.8]mm vs[56.4±11.4]mm,P<0.001;[25.4±3.3]mm vs[24.0±3.3]mm,P=0.002).Severe regurgitation was more frequently found in BAV with IE patients than isolated BAV patients(91.2%vs 49.0%,P<0.001),while BAV with IE patients were less common with aortic stenosis(16.2%vs 50%,P<0.001).Blood and node culture found that Streptococcus was the main pathogens in BAV with IE patients.The surgery was performed in 64(94.1%)BAV with IE patients without postoperative reoperation or death.Four patients received medical treatment,and 1 patient(1.5%)died for multi-organ dysfunction.One hundred and ninety-two(94.1%)isolated BAV patients received operation,and 2(1%)patients died during hospitalization.Six patients underwent reoperation for bleeding or perivalvular leakage.There was no significantly statistical difference in mortality and reoperation rates between the two groups.Conclusion BAV with IE patients were young,male predominant,few comorbidities,and high incidence of aortic valve regurgitation.Surgery remained the main treatment for BAV with IE patients,and the short-term outcome was comparable with isolated BAV.