感染性心内膜炎的外科治疗

目的：临床总结探讨30例感染性心内膜炎（IE）的外科治疗经验。方法：30例IE中，男22例，女8例；年龄3～50岁（平均26．3岁）；心功能（NYIIA）Ⅱ级5例，Ⅲ级19例，Ⅳ级6例。择期手术18例，急诊手术12例。施行二尖瓣替换术4例，主动脉瓣替换术6例（其中1例合并主动脉窦瘤破裂同期行窦瘤切除修补术，主动脉二尖瓣双瓣替换术8例，三尖瓣修复成形术2例；室间隔缺损修补术5例，动脉导管直视缝闭术4例，法乐氏四联症根治术2例，右室双腔心根治术1例。结果：本组死亡3例，死亡率10％，分别为主动脉二尖瓣替换术后并发多脏器功能衰竭、室颤各1例，法乐氏四联症术后低心输出量综合征1例。27例术后随访9～250个月（平均86．4个月），晚期死亡2例，均为人造瓣膜心内膜炎。存活25例（83．3％）术后心功能明显改善，心功能恢复至Ⅰ级者20例，Ⅱ级者4例，Ⅲ级1例。结论：外科治疗是难治性IE的有效治疗手段，IE手术成功的关键在于，尽可能清除感染病灶和彻底根治心脏基础疾病。

Surgical Treatment of Infectious Endocarditis

Objective: To summarize the surgical treatment experience of infectious endocarditis(IE). Methods: Eighteen patients with infective endocarditis received surgical intervention under cardiopulmonary bypass. Selective surgery were performed in 18 and emergent operation was necessary in 12 patients for intractable heart failure or arterial embolization. The principles of surgical approach are:(1)To remove vagetation and eradicate infective tissue. (2)To correct valvular disfunction and /or all of the associated defects. The surgical operations included aortic valve replacement(AVR) in 6; mitral valve replacement (MVR) in 4; combined aortic and mitral valve replacement (AMVR) in 8;tricuspid valve repair or/and reconstruction in 2; repair of ventricular septal defect in 5; suture of patent ductus arteriosus under direct vision in 4; correction of tetralogy of fallot (TOF) in 2; and double chambered right ventricle in 1.Results:There were 3 early died after operation,mortality is 10% ,2 cases died of multiple organ failure and ventricular fibrillation after AMVR, 1 died of low cardie output syndrome after correction of TOF. Follow - up of 9 to 250 months,average 86.4 months,documented 2cases died later due to proshetic valve endocarditis. Among the survival of 25(83. 3% ) .cardiac function (NYHA) was class I in 20, II in 4 and III in lease.Conclusion:Surgical intervention was effective measure for serious IE,the key to surgical operation was completely removing vagetation and eradicating infective tissue and properly correcting valvular disfunction and/or all of the associated defects.