先天性心脏病合并感染性心内膜炎的外科治疗

Surgical treatment for congenital heart disease complicated with infective endocarditis

目的探讨先天性心脏病合并感染性心内膜炎的临床特点及外科治疗经验。方法回顾性分析2015年1月至2019年12月我院心血管外科收治并行手术治疗的83例先天性心脏病并发感染性心内膜炎患者的临床资料及围术期治疗、手术方法。结果术后早期死亡2例,病死率2.4%,家属放弃救治2例,余患者顺利出院。术后最常见并发症为心衰(16.9%)、Ⅲ度/高度房室传导阻滞(8.4%)。随访3个月至5年,4例残余分流,其中2例自愈,6例人工瓣膜流速增快,无患者感染性心内膜炎复发,无患者需再次手术干预治疗。结论早期发现及规范的抗感染治疗,多学科团队合作,选择合适的手术时机,合理的手术方案,可取得良好的治疗效果。

Objective To summarize the clinical characteristics and surgical treatment experience of congenital heart disease complicated with infective endocarditis.Methods The clinical data including perioperative management and surgical approaches of 83 cases of congenital heart disease with active infective endocarditis admitted to the Department of Cardiovascular Surgery of our hospital between January 2015 and December 2019 were collected and retrospectively analyzed.Results Among the 83 patients enrolled,early postoperative death occurred in 2 cases,with an in-hospital mortality rate of 2.4%,2 cases were discharged voluntarily due to abandonment by their family member,and the remaining 79 patients recovered well.The 2 most common postoperative complications were heart failure(16.9%)and gradeⅢatrioventricular block(8.4%).During the follow-up of 3 months to 5 years,residual shunt occurred in 4 cases,with 2 of them being confirmed closed spontaneously,and peak prosthetic velocity and mean gradient increase occurred in 6 cases.No endocarditis recurred and none of the above so far needed surgical reintervention.Conclusion Early detection and standard anti-infection treatment,multidisciplinary team cooperation,appropriate timing of surgery,and retinal surgical procedure are the key factors to achieve good clinical efficacy.