自体瓣感染性心内膜炎的外科治疗

目的　总结自体瓣感染性心内膜炎 (NVE)外科治疗的时机和手术方法。方法　 2 0 0 1年 9月至 2 0 0 4年4月收治NVE患者 2 0例中男 14例 ,女 6例 ,平均 2 9.5岁。发病前无原发性瓣膜病变或心脏其它畸形者 4例 ,具有原发性瓣膜病变或心脏其它畸形者 14例 ,术前心功能Ⅱ级 3例 ,Ⅲ级 13例 ,Ⅳ级 4例。感染性病变侵犯主动脉瓣 13例 ,二尖瓣 8例 (其中主动脉瓣、二尖瓣均受损 5例 ) ,肺动脉瓣 6例 (1例合并二尖瓣受损 ,1例合并主动脉瓣受损 )。施行主动脉瓣和二尖瓣双瓣膜替换 5例 ,主动脉瓣替换 8例 ,二尖瓣替换 3例 ,肺动脉瓣赘生物摘除 1例 ,肺动脉瓣修补成形 5例。结果　本组 2 0例全部生存。 1例主动脉瓣瓣周脓肿合并左室右房瘘病人 ,主动脉瓣替换术后发生Ⅲ度房室传导阻滞。术后随访 1～ 2 4个月 ,心功能全部恢复至Ⅰ级 ,无瓣周漏 ,无再感染。结论　NVE首先应用抗生素抗感染治疗 ,右心瓣膜心内膜炎待感染进入稳定期后采取瓣膜修复术 ;而左心瓣膜心内膜炎 ,应依据患者心功能和赘生物的状态决定手术时机 ,心脏瓣膜替换术仍是左心瓣膜心内膜炎的有效手术方法。

Surgical treatment of native valve endocarditis

Objective To reviewe the timing of surgical inttervention and surgical procedure to the native valve endocarditis (NVE).Methods Between Appl 2001 and Appl 2004, 20 patients with a mean age of 29.5 years (range 5 to 49 years), with native valve endocarditis underwent surgery, concomitant cardiac abnormality included primery heart valve disease in 6 patients, conginital heart disease in 10. Preoperation heart function was Ⅱ class in 3 patients, was Ⅲ class in 13, was Ⅳ class in 4. Infection site was in aortic valve in 11 patients, in mitral valve in 8 patients, in pulmonary valve in 6 patients. Combine aortic and mitral valve replacement was performed in 4 patients, isolated aortic valve replacement was performed in 7 patients, isolated mitral valve replacement was performed in 3 patients, and pulmonary valve repair was performed in 5 patients.Results There was no operative death. The heart function of all patients was recovered to Ⅰ class.Conclusion The patients with NVE may be treated with antibiotic therapy frist, the timing of surgical intervention should be determined by the heart function and vegetation state, the right valve endocarditis could be operated with repair techniques as the endocarditis came into healed stage, and valve replacement was the effective surgical treatment to the left valve endocarditis.