主动脉窦瘤破裂合并感染性心内膜炎的外科治疗

目的 总结主动脉窦瘤破裂合并感染性心内膜炎的易感因素及治疗经验.方法 对2000年1月至2008年3月收治的30例主动脉窦瘤破裂中10例合并感染性心内膜炎的患者的临床资料进行回顾性分析.9例手术治疗,其中6例同时行主动脉瓣替换术.结果 9例行手术治疗患者均康复出院.随访2个月至8年,心功能恢复到Ⅰ级7例,Ⅱ级2例.死亡1例系未行手术治疗者,死于多脏器功能衰竭.结论 合并室间隔缺损是主动脉窦瘤破裂易感因素之一;主动脉窦瘤破裂合并感染性心内膜炎一经确诊,应足量有效抗炎治疗并尽早手术;合并中度以上主动脉瓣关闭不全应果断换瓣治疗.     

主动脉窦瘤破裂手术治疗的临床体会

目的 总结主动脉窦瘤破裂患者破裂类型及外科治疗经验.方法 对19例主动脉窦瘤破裂患者手术治疗情况进行回顾性分析.合并室间隔缺损10例,主动脉瓣关闭不全6例,其他畸形6例(有的同时合并几种畸型),并发感染性心内膜炎2例.所有患者均及时施行了手术治疗.结果 发生于右冠状动脉窦者15例,其中12例破入右室,3例破入右房;发生于无冠状动脉窦者3例,其中1例破入右室,2例破入右房;发生于左冠状动脉窦者1例,破入左室.全组无手术死亡,1例出现主动脉瓣轻至中度返流,全部患者均痊愈出院.结论 主动脉窦瘤以右冠状动脉窦瘤最常见,且多数破入右室;主动脉窦瘤破裂一经确诊,应尽早手术治疗,以免延误手术时机,合并感染性心内 膜炎尤其如此.

Abstract：

Objective To summarize the ruptured types and surgical treatment experience for rupture of aortic sinus aneurysm. Methods Nineteen cases with aneurysm of aortic sinus were retrospectively analyzed. There were 10 cases with ventricular septal defect,6 cases with aortic valvular incompetence,6cases with other diseases,2 cases complicated by infective endocarditis. All cases underwent operational treatment. Results There were 15 cases of right aneurysm of aortic sinus,including 12 cases among them ruptured into right ventricle,3 cases rupture was penetrated into right atrium.There were 3 cases of null aneurysm of aortic sinus,including 1 case among them ruptured into right ventricle,2 cases ruptured into right atrium. There was 1 case of left aneurysm of aortic sinus, which ruptured into left ventricle. No operative death occurred in all, 1 case with aortic regurgitation light to moderate,and all cases were recovered.Conclusions The right aneurysm of aortic sinus is the most common types,and always rupture into right ventricle. It is important that aneurysm of aortic sinus should be operated as early as possible in order to avoid losing the chance of operation, particular in the patients complicated by infective endocarditis.     

Cardiovascular abnormalities in Marfan syndrome]

During the period February to December 1990, 52 adult patients were referred to our clinic for evaluation of the presence of the Marfan syndrome. In 24 out of 52 patients the Marfan syndrome was diagnosed. Cardiac abnormalities were found in all patients: mitral insufficiency because of mitral valve prolapse (83%), aortic dilatation (67%), aortic insufficiency (38%), tricuspid valve insufficiency with or without tricuspid valve prolapse (17%) and atrial septal defect (4%). In 3 patients an aneurysm of the ascending aorta was found. Early recognition of the Marfan syndrome is relevant for prevention of the life threatening complication of aortic dissection. In patients with valve abnormalities endocarditis prophylaxis is advised. A Marfan outpatient clinic offers optimal diagnostic possibilities.     

先天性心脏病继发感染性心内膜炎的外科治疗

目的总结先天性心脏病继发感染性心内膜炎的外科治疗经验。方法手术治疗先天性心脏病合并感染性心内膜炎65例,手术原则是清除感染灶,矫治心脏畸形和恢复瓣膜功能,行室间隔缺损修补52例,动脉导管直视缝合8例,主动脉窦瘤修补2例,法洛四联症根治3例,同期行二尖瓣成形2例,三尖瓣成形12例,肺动脉瓣成形5例,二尖瓣置换2例,主动脉瓣置换3例,三尖瓣置换1例,二尖瓣主动脉瓣置换2例,主动脉根部置换1例。结果1例急诊行法洛四联症根治术后并发低心排综合征死亡;其余患者均痊愈出院。随访60例,随访6个月～10年,无1例死亡及心内膜炎复发。结论先天性心脏病继发感染性心内膜炎者正确选择手术时机及有效的抗生素是提高治愈率的关键。     

Descriptive epidemiology of selected congenital heart defects, Hawaii, 1986-1999

Congenital heart defects are the most common type of birth defect and contribute the most to infant mortality due to birth defects. This study examined the relationship between several demographic factors and selected congenital heart defects among the unique multiethnic population in Hawaii during 1986-99, using data from a population-based birth defects registry. Rates were significantly higher in 1993-99 than in 1986-92 for transposition of the great arteries and Ebstein's anomaly, and significantly lower for tetralogy of Fallot. Significantly elevated rates were found with maternal age of > or =35 years for ventricular septal defect, atrial septal defect, endocardial cushion defect, and hypoplastic left heart syndrome. When cases with a known chromosomal abnormality were excluded, elevated rates among the older maternal age group remained for ventricular septal defect, atrial septal defect, and hypoplastic left heart syndrome. Whites had significantly higher rates than one or more of the other racial/ethnic groups for Ebstein's anomaly and coarctation of aorta, and significantly lower rates for tetralogy of Fallot, atrial septal defect, pulmonary valve atresia/stenosis, tricuspid valve atresia/stenosis, and anomalous pulmonary venous return. Significantly higher rates were found among males for transposition of great arteries, aortic valve stenosis, and interrupted aortic arch and, among females, for ventricular septal defect, endocardial cushion defect, and anomalous pulmonary venous return. Some of these differences were consistent with the literature while others were not.     

Birth weight and cardiovascular malformations: a population-based study. The Baltimore-Washington Infant Study

Mean birth weights were evaluated in infants with D-transposition of the great arteries, tetralogy of Fallot, endocardial cushion defect, hypoplastic left heart syndrome, pulmonary stenosis, aortic stenosis, coarctation of the aorta, ventricular septal defect, and atrial septal defect in a population-based case-control study of congenital cardiovascular malformations in residents of Maryland, Washington, D.C., and northern Virginia (1981-1987). Study subjects were liveborn singletons without extracardiac anomalies. After adjustment for potentially confounding maternal, gestational, and infant factors, significant birth weight deficits were found for infants with tetralogy of Fallot, endocardial cushion defect, hypoplastic left heart syndrome, pulmonary stenosis, coarctation of the aorta, ventricular septal defect, and atrial septal defect. After adjustment, infants with these malformations (except coarctation of the aorta and atrial septal defect) were also significantly more likely than were controls to have low birth weight for gestational age. These findings strengthen previous evidence that certain cardiovascular malformations and low birth weight may be causally related.     

Clinical use of biplane transesophageal echocardiography]

The clinical value of biplane transesophageal echocardiography (TEE) was assessed on basis of the experience of the first 100 cases. All studies were performed in awake patients, there was no complication or failure. There wee 43 males and 57 females, aged between 13 and 82 years. The indication of TEE was infective endocarditis in 33, congenital heart disease in 25, suspected tumor or thrombus in 18, search for source of embolism in 9, thoracic aortic pathology in 9, prosthetic valve dysfunction in 3 and other problems in 3 cases. Biplane technique provided additional information as compared to single plane TEE in the diagnosis of infective endocarditis (by the visualization of small vegetations and of mitral valve fenestration, and by the differentiation of mitral vegetation from prolapse or aneurysm), in the identification of source of embolism (by easier visualization of patent foramen ovale and of the left atrial appendage thrombus), in the imaging of ascending aorta, of right ventricular outflow tract and of the left ventricular endocardium. Biplane technique enhanced therapeutic decision making particularly in the indications of anticoagulant treatment and in planning certain cardiac operations. Biplane TEE is an easily acquired technique and it will replace single plane TEE in a number of indications.     

先天性心脏病复合畸形的临床介入治疗策略探讨及评价

目的研究先天性心脏病复合畸形经心导管介入治疗的病例选择、手术方法、疗效、安全性及评价。方法选择2008年1月至2008年12月在本院接受同期介入治疗的11例复合型先天性心脏病患儿为研究对象。其中,男性患儿为3例,女性为8例,平均年龄为（4.08±2．64）岁,最小为5个月,最大为10岁。本组先天性心脏病复合畸形类型包括：3例室间隔缺损（ventricular septal defect,VSD）合并动脉导管未闭（patent ductus arteriosus,PDA）,3例房间隔缺损（atrial septal defect,ASD）合并肺动脉瓣狭窄（pulmonary stenosis,PS）,2例房间隔缺损合并动脉导管未闭,1例房间隔缺损合并室间隔缺损,2例动脉导管未闭合并主动脉缩窄（coarctation of aorta,COA）,其中1例为同期介入治疗。介入治疗复合畸形的顺序为：肺动脉瓣球囊扩张术或主动脉球囊扩张术、室间隔缺损封堵术、动脉导管未闭封堵术、房间隔缺损封堵术（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,取得受试对象的知情同意,并与试验患儿监护人签署临床研究知情同意书）。结果11例患儿均成功封堵,手术顺利。术后X射线心脏造影及彩超提示,封堵器成形好,未见残余分流。术中、术后均未见严重并发症。其中,1例室间隔缺损术后心电图提示不完全右束支传导阻滞,给予地塞米松治疗后,心电图复查正常。结论介入治疗单纯性先天性心脏病的技术目前比较成熟,成功率高,但复合型先天性心脏病同期进行介入治疗,其操作较复杂,技术难度较高。本研究证明,若掌握恰当手术指征,制定合理操作策略,手术过程仔细、谨慎,介入治疗的可行性、安全性是较肯定的。     

Endocardite infectieuse à Bartonella henselae précédée par la rupture d’un anévrisme cérébral

We report a case of severe aortic bicuspid valve endocarditis, revealed by global cardiac failure without fever, in a 38-year-old man who had developed cerebral mycotic aneurysms nine months earlier. PCR analysis of the excised aortic valve and serological tests (even 9 months earlier) were positive for Bartonella henselae. A combination of intravenous then oral doxycyclin at 200 mg/day and intravenous gentamycin at 90 mg/day was given for 6 and 2 weeks respectively. The evolution was favorable on follow-up, 12 months after completion of the therapy. Only 49 cases of B. henselae endocarditis have been reported to date, none with associated mycotic aneurysm but most often located on the bicuspid aortic valve, and usually with severe valvular damage due to late diagnosis.     

Aortic endocarditis complicated with a large ventricular septal defect and septic pulmonary embolism

BACKGROUND: Infectious complications of the aortic valve can lead to severe cardiac failure and widespread contiguous lesions by the involvement of subaortic structures such as aorto-left ventricular discontinuity, destruction of the aortic ring, aortic abscesses, true or false aneurysms and shunts. AIM: Report a new case of a large ventricular septal defect due to infection. CASE REPORT: Abnormal communications occurring during acute aortic valve endocarditis are rare but they are very serious complications. We report a case of a 58 year-old-man, referred to our hospital with the diagnosis of aortic endocarditis with complicating root abscesses, acquired ventricular septal defect (VSD) and pulmonary septic embolism. Surgery was indicated and the whole procedure was performed through the aortic root. The patient underwent a radical resection of the abscesses, reconstruction of the aortic ring, closure of the ventricular septal defect and prosthetic replacement of the aortic valve. The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse. CONCLUSION: The authors would like to select and analyze some weaknesses of their procedure like using only the transaortic access that often limits exposure of possible right-side lesions, not removing the pulmonary obstruction and using an important amount of foreign material to reconstruct subvalvular lesions.     

Cases of infective endocarditis caused by Campylobacter fetus

An 18-year-old man with infective endocarditis caused by Campylobacter fetus is reported. This bacterial species has long been of interest in veterinary medicine, and recently it has been reported to be one cause of infantile diarrhea. Infective endocarditis arising from campylobacter fetus is rare. This is the fourth case reported in Japan. The organism was resistant to several antibiotics, and large vegetations were found to involve the aortic valve. Emergency excision of the infected aortic valve and replacement with a valve prosthesis were successful. Current clinical treatment of infective endocarditis is discussed, and the literature briefly reviewed.     

Screening for Q Fever in Patients Undergoing Transcatheter Aortic Valve Implantation,Israel, June 2018–May 2020

Q fever infective endocarditis frequently mimics degenerative valvular disease. We tested for Coxiella burnettii antibodies in 155 patients in Israel who underwent transcatheter aortic valve implantation. Q fever infective endocarditis was diagnosed and treated in 4 (2.6%) patients; follow-up at a median 12 months after valve implantation indicated preserved prosthetic valvular function.     

Surgical management of aneurysm of the ascending aorta associated with aortic valve insufficiency

Out of 318 aortic valve replacements performed between July 1, 1984 and June 30, 1989, aneurysm of the ascending aorta was found in 17 cases. In 7 of these cases employment of conduit was required due to the dimension of the aneurysm. In 5 cases they performed Bentall procedure: aortic valve replacement combined with conduit of the ascending aorta with the replantation of the coronaries. Based on the data of the literature and the acceptable early and late results of their own they conclude, that in case of simultaneous occurrence of aortic valve disease and aneurysm of the ascending aorta the Bentalll procedure is the method of choice.     

心脏内畸形合并感染性心瓣膜炎的外科治疗

目的探讨心脏内畸形合并感染性心瓣膜炎的诊断及外科治疗特点。方法回顾1997年2月-2003年2月10例心脏内畸形合并感染性心瓣膜炎患者的临床资料，其中室间隔缺损4例，主动脉窦瘤破裂2例，右室流出道狭窄1例，二尖瓣关闭不全1例，主动脉瓣二叶瓣畸形2例。感染的心脏瓣膜分别为主动脉瓣4例。三尖瓣4例，肺动脉瓣1例，二尖瓣1例。合并瓣膜赘生物9例次，合并瓣膜穿孔4例次，均行外科手术治疗，清除赘生物及修复穿孔，同时行室间隔缺损修补术、主动脉瓣置换术、二尖瓣置换术、右室流出道加宽补片术1例。结果患者术后7-14d体温及白细胞计数降至正常，应用抗生素28d后痊愈出院，全组无死亡病例。结论心脏内畸形患者并发感染性心瓣膜炎，如发现瓣膜赘生物形成或瓣膜穿孔，应视病情立刻手术或抗感染治疗后手术，术后根据血细菌培养或瓣膜赘生物培养情况应用抗生索28d，预防人工瓣膜及补片再度感染。     

Tetralogy of fallot with absent pulmonary valve

BACKGROUND: Absent pulmonary valve with ventricular septal defect is a rare cardiac malformation. The aim of our study is to specify the anatomic characteristics and the clinical and echocardiographic features of this cardiac malformation and to discuss its management. METHODS: We report 8 cases of absent pulmonary valve with ventricular septal defected collected over a period of 24 years. The diagnosis was made during the first year of life in all cases in the presence of respiratory symptoms and/or cyanosis. It was confirmed by cardiac catheterization in 4 cases and echocardiography in 4 cases. RESULTS: Pulmonary vascular obstructive disease, related to aortopulmonary collateral vessels, was noted in one patient who died at the age of 20 years. One patient was lost to follow up and 6 patients were operated. Closure of the ventricular septal defect, widening of the pulmonary tract and insertion of a pulmonary valve were performed in the 6 cases. Reduction procedure of the pulmonary arteries was performed in 3 cases. One death related to early postoperative infective endocarditis was noted. At a mean follow up of 2 years, the 5 survivors are going well with no significant pulmonary stenosis. CONCLUSION: Although named "tetralogy of Fallot with absent pulmonary valve", absent pulmonary valve with ventricular septal defect is different from tetralogy of Fallot by aneurysmal dilatation of the pulmonary arteries which may compress the bronchial tree and lead to respiratory symptoms that can be severe with respiratory distress. Pulmonary arterioplasty eliminate airways obstruction and its results are satisfactory. The need for insertion of a pulmonary valve is debatable.     

先天性主动脉瓣下狭窄的超声诊断分析

目的 探讨主动脉瓣下狭窄(SAS)的超声心动图诊断价值.方法 回顾性分析30例SAS的超声心动图特征及手术所见.结果 单纯SAS 9例,其中隔膜型3例,肌肥厚性5例,二尖瓣畸形导致的1例.21例合并有其他心血管畸形,其中室间隔缺损(VSD)6例,动脉导管未闭(PDA)7例,主动脉瓣狭窄(AA)5例、主动脉缩窄(COA)3例.根据三尖瓣反流、心内或大血管水平分流压差,估测肺动脉收缩压52～75mm Hg.2例患者漏诊弥漫型SAS;1例被误诊为肥厚型心肌病(HCM).结论 SAS合并其他心血管畸形在解剖、血流动力学上有许多特异之处,把握其特殊表现,有助于超声心动图做出准确诊断,从而为手术治疗提供有价值的参考.     

Aortic infectious endocarditis on native valve

Between 1990 and 2002, 32 patients with mean age of 34 years has been treated for an aortic infective endocarditis on native valve. All the patients had recognised heart disease before developing the infection. 24 patients are operated for aortic valve replacement. The hospital mortality was 15.6% (5 patients). The mean follow-up was 47.4 months. The survival rate was 75%. Aortic infective endocarditis remains a serious affection with poor prognosis, despite the contribution of echocardiography and advances in antimicrobial therapy and cardiac surgery. Significants morbidity and mortality are usually caused by sequele of the disease rather than by the infection itself.     

Porcine bioprosthetic aortic valve endocarditis with ring abscess and aortic stenosis

Porcine bioprosthetic valve endocarditis is an infrequent but serious complication of valve replacement surgery. Ring (or annular) abscess is a frequent finding in mechanical valve endocarditis. In contrast, porcine valve endocarditis most often involves the cusps, and annular infection is uncommon. Porcine valvular dysfunction secondary to endocarditis usually takes the form of incompetence, whereas stenosis is less frequent. We report a case of a 76-year-old female who developed endocarditis with Staphylococcus epidermidis nine months after placement of a Carpenter-Edwards porcine aortic valve. Her initial presentation included complete heart block and moderate aortic stenosis. Transesophageal echocardiography aided the diagnosis by demonstrating large vegetations, while transthoracic echocardiography showed only slight thickening of the valve leaflets. At operation, there was a circumferential abscess around the sewing ring causing valve dehiscence and virtual discontinuity of the aorta from left ventricle. Valve degeneration and organisms within the cusps were observed on microscopy. This case illustrates two infrequent complications of porcine aortic valve endocarditis, namely massive annular abscess with invasion of the conducting system and aortic stenosis. It also demonstrates the utility and limitations of transesophageal echocardiography in the diagnosis of this disorder.     

Redo procedures for correction of aortic valve diseases in infants and children. The Bentall-Konno procedure

On an infant with critical valvular aortic stenosis balloon-valvoplasty, and 3 years later because of the aortic valve regurgitation Ross operation was performed. In the early postoperative period an aortic-root abscess occurred due to an infective endocarditis; the aortic root was corrected by homograft implantation. Due to a relatively small, calcified aortic valve, with aortic valve regurgitation grade III at the age of 12 years, a Bentall-Konno procedure was performed successfully. This is the first case when this complex surgical procedure was performed successfully on a child in Hungary.     

Large ostium secundum atrial septal defect discovered after severe mitral regurgitation. A case report

Mitral regurgitation is associated with ostium secundum atrial septal defect in about 22% of cases. mitral valve prolapse induced by atrial shunt is the main cause of this regurgitation. Ususually, atrial septal defect discovery precedes that of mitral regurgitation. The aim of this paper is to focus on clinical, hemodynamic and evolutive details of atrial septal defect and mitral regurgitation association. We report the case of large atrial septal defect in 37 years old girl referred for hemodynamic investigation of mitral regurgitation. The divergence of clinical data, electrocardiogram and echocardiography findings has led to atrial septal defect discovery. Hemodynamic data showed severe pulmonary arterial hypertension (medium pulmonary arterial pressure: 45 mmhg). Hence, mitral valve substitution by mechanical prosthesis and closure of atrial septal defect have been carried out. Ten hours after surgery, death occurred because of severe pulmonary arterial hypertension and heart failure. CONCLUSION: Association of severe mitral regurgitation and large ostium secundum atrial septal defect is an original anatomo-clinic entity caracterized by mitral valve lesions diversity and severe secondary pulmonary arterial hypertension. Danger of such a hypertension is due to progressive and infra clinical rise of pulmonary resistances and association of increased pulmonary blood flow and capillary pulmonary hypertension.