超声心动图对感染性心内膜炎的诊断价值分析

目的分析超声心动图对感染性心内膜炎(IE)的诊断价值。方法选取内蒙古医科大学附属医院2015年3月—2016年3月收治的IE患者89例,均进行超声心动图检测,观察瓣膜受累情况、赘生物附着部位并测量其大小。结果血培养阳性患者30例(33.7%),其中革兰阴性杆菌9例,革兰阳性球菌21例。经超声心动图检查发现心脏瓣膜赘生物形成患者85例(95.5%),其中主动脉瓣30例、左房室瓣21例、主动脉瓣和左房室瓣13例、右房室瓣11例、肺动脉瓣10例;赘生物直径10 mm者45例、11~15 mm者33例、16~20 mm者5例、21 mm者2例。结论超声心动图检查能能快速发现并准确定位IE患者心脏瓣膜赘生物,诊断价值良好。     

超声心动图诊断感染性心内膜炎的临床价值分析

目的探讨感染性心内膜炎的临床特征和超声心动图对其的诊断价值。方法回顾性分析61例感染性心内膜炎患者的临床资料和超声心动图表现,并与手术、病理结果进行比较。结果感染性心内膜炎基础病因主要为先天性心脏病和风湿性心脏病,但比例有所下降;临床表现不典型病例增多,血培养的阳性率仅为22.9%。超声心动图对赘生物的检出率为85.2%,有助于早期诊断。赘生物分布位置、回声等具有其超声特点,超声心动图可检出瓣膜穿孔、腱索断裂、瓣周脓肿等并发症。结论超声心动图能够准确检出感染性心内膜炎赘生物和其并发症,对指导临床治疗和判断预后具有重要的临床应用价值。     

经胸超声检查不典型感染性心内膜炎的效果观察

目的探讨经胸超声检查不典型感染性心内膜炎的效果。方法选取2009年1月~2016年3月我院所收治的不典型感染性心内膜炎患者20例作为研究对象,均接受外科手术治疗手段,通过胸超声心动图检查后再进行手术,比较超声检查结果与手术后手术结果,对超声心动图检查的准确性进行分析。结果所有患者中,有赘生物存在18例,超声心动图检测有赘生物存在15例,检出率为90%,超声诊断正确率为75%,手术结果在瓣膜损害和赘生物附着部位检测正确率比较,差异无统计学意义(P0.05)。结论在临床检测不典型感染性心内膜炎患者,经胸超声心动图可以能准确快速地发现赘生物,符合手术检查的结果率较高,效果良好,说明经胸超声心动图检查有较强特异性,可成为主要的检查手段。     

右心瓣膜感染性心内膜炎

右心瓣膜感染性心内膜炎是指三尖瓣和肺动脉瓣的感染性炎症,近年来发病有增多趋势,其病因、临床表现、治疗和预后与左侧心脏心内膜炎有所不同。根据静脉内滥用药物或肺动脉插管等病史,结合超声心动图发现瓣膜赘生物及阳性血培养,多能作出准确诊断。早期有效的抗生素治疗和/或外科治疗,可减少并发症和降低病死率,抗凝治疗对>1cm 的赘生物可有裨益。     

切面超声心动图诊断感染性心内膜炎赘生物及临床意义

某些感染性心内膜炎赘生物可被超声心动图所识别,提示并发症发生率高,预后差。切面超声心动图在检出赘生物方面的敏感性较 M 型超声心动图为高.本文作者研究切面超声心动图诊断赘生物的准确性,并试图确定活动性感染性心内膜炎病人的赘生物和临床并发症发生率之间关系。     

婴幼儿原发性心脏肿瘤超声心动图诊断分析

目的探讨超声心动图在婴幼儿原发性心脏肿瘤诊断中的应用价值。 方法选取26例疑似原发性心脏肿瘤婴幼儿,均行超声心动图检查,完善相关检查后,经手术或穿刺活检明确诊断,分析超声心动图对原发性心脏肿瘤的诊断价值。 结果26例疑似心脏肿瘤患儿中,1例确诊为原发性心脏肿瘤,属心脏黏液瘤(良性);25例确诊为心内膜炎,其中19例伴瓣膜赘生物。超声心动图诊断2例原发性心脏肿瘤,其中1例为心内膜炎赘生物误诊为心脏肿瘤,诊断敏感度为100.0%,特异度为96.0%,与病理诊断符合率为96.15%。 结论超声心动图诊断婴幼儿原发性心脏肿瘤具有较高敏感度,可为临床正确诊断提供客观依据,有利于治疗方案的制定与实施。     

食管超声心动图改进心内膜炎并发脓肿的诊断

众所周知,超声心动图是非侵入性诊断感染性心内膜炎患者瓣膜赘生物的首选方法,而经食管超声心动图比经胸超声心动图精确。在很多病例,经胸超声心动图诊断瓣周脓肿比较困难,甚至不可能。经食管超声心动图是否优越尚不清楚。为了探讨经食管超声心动图对心内膜炎并发瓣周脓肿的诊断价值,作者采用经胸和经食管二维超声心动图前瞻性连续观察118例患者发生心内膜炎的137个自身或人工瓣膜,随后均经尸检或手术证实。     

主动脉瓣感染性心内膜炎的超声诊断特征及其对判断预后的意义

本文报告15例主动脉瓣感染性心内膜炎的超声特征,对主动脉瓣上赘生物、穿孔或撕裂的形态及活动作了描述,并提出超声心动图对本病有很可靠的诊断价值,对指导临床治疗及估计预后极为重要。     

感染性心内膜炎161例手术治疗及诊断依据探讨

目的:探讨感染性心内膜炎的临床诊断依据,为感染性心内膜炎手术治疗提供临床参考。方法:回顾分析北京安贞医院心外九病区近10年来(2007年1月至2016年12月)手术治疗感染性心内膜炎患者临床资料(基本情况、血常规、肝肾功能、血培养、心电图、超声心动图、手术情况),以改良Duke标准为诊断依据。结果:161例患者中,术前有反复发热病史126例,占78.3%;术前行血培养149例,阳性率20.1%;术前超声发现瓣膜赘生物130例,阳性率80.7%。依照改良Duke标准,术前确诊8例,疑似诊断106例,另有47例患者为手术中证实。结论:超声心动图是感染性心内膜炎的重要诊断手段,重复多次检查有助于提高诊断阳性率;加强对感染性心内膜炎的认识、充分详实的病史采集、体格检查、以及实验室数据将有助于临床诊断率的提高。     

经食管三维超声心动图在二尖瓣位感染性心内膜炎中的应用

目的评价经食管三维超声心动图（three-dimensional transesophageal echocardiography,3D-TEE）在二尖瓣位感染性心内膜炎（infective endocarditis,IE）中的应用价值。方法选择2008年6月至2012年5月期间,在广东省人民医院行超声心动图检查并结合临床诊断,最终经手术病理确诊为二尖瓣位IE患者20例为研究对象。所有患者术前均行经胸超声心动图（transthoracic echocardiography,TTE）及3D-TEE检查。以病理为金标准,比较TTE及3D-TEE对诊断心内膜受累各种表现形式的敏感性和特异性。结果手术病理证实二尖瓣位赘生物20例,合并瓣膜穿孔11例,瓣周脓肿3例,瓣膜瘤2例,人工瓣撕脱3例。TTE及3D-TEE诊断赘生物的敏感性为80%vs.90%,特异性为57%vs.86%;诊断瓣膜穿孔的敏感性为72%vs.91%,特异性为78%vs.89%;诊断瓣周脓肿的敏感性为33%vs.66%,特异性为82%vs.94%;诊断瓣膜瘤的敏感性为50%vs.100%,特异性为94%vs.94%;诊断人工瓣撕脱的敏感性及特异性均为100%。3D-TEE对赘生物的检出率均高于TTE,差异有统计学意义（P〈0.05）。结论 3D-TEE对诊断IE各种表现形式均有较高的敏感性和特异性,能准确显示赘生物位置、形态、大小及其与周围心脏结构的空间关系,对临床治疗方案的选择及预后评估有重要作用。     

Has Transesophageal Echocardiography Changed the Approach to Patients with Suspected or Known Infective Endocarditis?

Infective endocarditis is still a great clinical challenge. Its diagnosis is difficult to establish, and mortality has remained around 30%. Early diagnosis and optimal treatment are crucial fo prognosis improvement. Echocardiography plays an indispensable role in the management of this disease, especially with the recently introduced approach, transesophageal echocardiography (TEE). TEE can overcome the limitations of transthoracic echocardiography (TTE) and is superior to TTE in almost every way in providing earlier and more information for the diagnosis and treatment of infective endocarditis. TEE detects valve vegetations with much higher sensitivity and specificity than TTE. It can demonstrate smaller vegetations in the early stage of the disease and vegetations on atypical locations (e.g., mitral valve annulus), and provides detailed characterization of vegetations (e.g., location, size, mobility, and changes during treatment). Such information is of great prognostic value and may help in selecting proper treatment. TEE is more sensitive for detecting complications, such as mitral valve perforation, abscess, and subaortic complications, which respond poorly to medicine and for which timely surgery may be the best treatment. For those with prosthetic valve endocarditis, TEE is especially useful because TTE is greatly limited by the acoustic shadow of prostheses. Both positive and negative results of TEE examination are valuable for confirming or excluding infective endocarditis. TEE also plays a unique role in intraoperative monitoring and can assess surgical results before the chest is closed. TEE has become an invaluable tool for the diagnosis and management of patients with suspected or known infective endocarditis.     

Improved detection of infective endocarditis with transesophageal echocardiography.

The incremental advantage of transesophageal echocardiography was determined by comparing results of paired transthoracic and transesophageal echocardiographic examinations performed in 61 patients for evaluation of suspected infective endocarditis. According to clinical and pathologic data, 31 of 61 (51%) patients had finding that were positive for infective endocarditis. Studies were graded as positive or negative for vegetations and were also graded for image quality. The sensitivity of transesophageal echocardiography in detecting vegetations was 88% versus 30% for transthoracic studies (p less than 0.01). For patients with aortic valve infective endocarditis, transesophageal sensitivity was 88% versus 25% for transthoracic sensitivity, because transesophageal echocardiography successfully separated vegetations from chronic valve disease caused by sclerosis or calcification (p less than 0.01). For patients with mitral valve infective endocarditis, transesophageal sensitivity was 100% versus 50% for transthoracic sensitivity, because transesophageal echocardiography distinguished vegetations from myxomatous changes or detected vegetations on prosthetic valves (p less than 0.01). Thus transesophageal echocardiography improves recognition of infective endocarditis, particularly in the presence of underlying valvular disease.     

Role of echocardiography in the diagnosis and management of infective endocarditis

Infective endocarditis is a life-threatening disease with significant morbidity and mortality. Accurate and early diagnosis for initiation of effective treatment is essential in improving patient outcome. Echocardiography is currently the primary modality for the detection of vegetations and cardiac complications that result from endocarditis. Technological advances in echocardiography, particularly the development of transesophageal echocardiography (TEE), have revolutionized the diagnosis and management of infective endocarditis. With the enhanced resolution provided by TEE, vegetations and paravalvular complications can be reliably detected. Transthoracic and transesophageal echocardiography provides complementary information for patient management and follow-up, and is best used in conjunction with clinical data. By means of its high sensitivity and negative predictive value, TEE is essential in the evaluation of prosthetic valve endocarditis and the paravalvular complications of IE. All patients with suspected infective endocarditis should undergo transthoracic echocardiography, and most of these patients should also undergo TEE evaluation. The role of new technology such as harmonic and three-dimensional imaging is yet to be determined.     

Intractable infective endocarditis associated with supraaortic stenosis in Williams syndrome: a case report

A 17-year-old man with supravalvular aortic stenosis associated with Williams syndrome was admitted to our hospital for intensive treatment for intractable infective endocarditis. The patient had a history of percutaneous balloon valvuloplasty for aortic stenosis in 1992. He was well until late in 1999, when he had a high temperature after dental work-up. The diagnosis was infective endocarditis but antibiotic therapy was not effective. He was transferred to our clinic. Transthoracic echocardiography demonstrated bicuspid aortic valve, supraaortic stenosis, mitral valve prolapse with severe regurgitation and scattered vegetations on the anterior mitral and aortic valves. In addition, transesophageal echocardiography showed innumerable mobile vegetations located from Valsalva's sinus to the descending aorta. Aortic root and arch replacement with a homograft and mitral valve replacement with an artificial valve were successfully performed to eliminate the infective endocarditis. In the present patient, the flow jet across the supraaortic stenosis seemed to cause a predisposition to severe endocarditis.     

Echocardiographic assessment of vegetations in patients with infective endocarditis: prognostic implications

Today, echocardiography is the most important technique next to clinical findings and blood cultures in the diagnosis of infective endocarditis. The sensitivity of echocardiography, particularly the transesophageal approach, for detection of vegetations and endocarditis related valvular destructions is high. In addition, echocardiographic findings may have some prognostic implications. The size and mobility of vegetations stratifies endocarditis patients into a high risk group for arterial embolism. In particular, mobile vegetations attached to the mitral valve with a maximal diameter > 10 mm may be prone to embolic events. Furthermore, increase in size of vegetations during antimicrobial treatment may identify patients with no, or at least a prolonged, healing process. Also, a lack of increase in the echo density of vegetations under adequate antibiotic treatment may indicate a poor healing process and may necessitate more aggressive management. The demonstration of paravalvular abscesses by echocardiography, particularly by transesophageal echocardiography, identifies a subgroup of patients who will need urgent cardiac surgery before widespread tissue destruction has occurred.     

Infective endocarditis: transesophageal echocardiography in all or in selected cases? When is echocardiography highly predictive for complications?

Echocardiography is currently considered one of the most important tools in the diagnosis and treatment of infective endocarditis (IE). However, its use leaves a number of issues open. Since transthoracic echocardiography (TTE) cannot define structures and vegetations < 4 mm, transesophageal echocardiography (TEE), though more costly and invasive, is superior to TTE in the diagnosis of IE. TEE should be recommended immediately in patients with valve prostheses and in those with a native valve and an intermediate or high pre-test probability of disease. In patients with a low probability of disease, a completely negative examination without the slightest valvular anomaly practically excludes the likelihood of IE; however, the patient should still be followed up. In patients with a very low probability of disease, echocardiography is not necessary; instead, reassessment can be performed at some future time. Echocardiography has a high prognostic value in IE since it may reveal intracardiac complications due to this disease and contributes to a better understanding of the clinical complications. Moreover, echocardiography may also aid in the choice of surgery timing and thus modify the clinical progression of the disease. Large and extensive vegetations that are more mobile and soft are more closely associated with the development of complications and embolic events. Despite numerous reports, uncertainty surrounds the approach to treatment when echocardiography discloses vegetations at risk of embolization in uncomplicated IE and in the absence of other indications for surgery.     

Value of echocardiography in detection of vegetation and their clinical significance

The aim of the study was to assess usefulness of echocardiography in bacterial vegetations detection as well as their clinical value as the indicator for surgical treatment. 44 patients aged 16-65 (mean 37.6) with infective mitral and aortic valve endocarditis underwent the study. Authors assessed clinical state taking into consideration blood culture tests as well as M-mode and parasternal and apical projections two-dimensional echocardiographic examinations. Data were compared with intraoperative or pathomorphological findings to estimate specificity and sensitivity of echocardiography in bacterial vegetation detection. Vegetations were pathomorphologically or intraoperatively stated in 21 patients (48%). M-mode echocardiography revealed changes in 16 patients, and two-dimensional one in the next 3. In the group of 23 patients without vegetations, concordance between intraoperative findings and echocardiographic results was stated in 19 subjects. Therefore, sensitivity and specificity of two-dimensional echocardiography were respectively 91% and 83%. Vegetations stated in two-dimensional echocardiographic examination had an unfavourable prognosis. Embolic complications were observed in 14, and myocardial infarction in 7 of 21 patients with bacterial vegetations. Authors thought it advisable to early operate on such patients. Whereas in patients without vegetations embolic complications were stated only in 3, and myocardial infarction in 1 patient. Therefore two-dimensional echocardiography making bacterial vegetations detection possible in patients with infective valve endocarditis allows to identify patients with higher risk of thromboembolic complication or death.     

Significance of the detection of echocardiographic vegetation for the clinical course and prognosis of infectious endocarditis

52 patients with infective endocarditis and manifestations on 62 valves were examined by echocardiography between January 1978 and May 1983. In 34 patients (65%) vegetations were visible at least on one valve, in 10 patients (19%) the result was doubtful and in 8 patients (16%) no vegetations could be seen. In a comparison of echocardiographic and intraoperative or autopsy findings, with doubtful results left out, the over-all sensitivity was 96%, specifity 44% and reliability 83%. There was no statistically significant difference in echocardiographic results between patients who were operated upon or treated medically. Patients with positive echocardiographic vegetations had no statistically significant higher risk of embolism. Morphological aspects of the vegetations had no influence on clinical course and prognosis either. All 12 patients (23%) who died had positive echocardiographic vegetations. Yet the difference from the surviving group was not significant. Hence, echocardiography is a sufficiently sensitive and reliable method for the detection of vegetations in patients with infective endocarditis. However, echocardiographic findings alone are of no consequence in medical or surgical treatment, arterial embolization or prognosis.     

Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality

The echocardiograms and clinical records of 70 patients with infective endocarditis seen between 1983 and 1988 were examined to evaluate the role of two-dimensional and Doppler echocardiography in the diagnosis of infective endocarditis and identify risk factors for morbidity and mortality. A blinded observer reviewed the echocardiograms for the presence and size of vegetations and the severity of the valvular regurgitation. Vegetations were identified in 54 (78%) of 69 technically satisfactory echocardiograms. In 38 patients whose heart was examined at surgery or autopsy, all vegetations diagnosed by echocardiography were confirmed, but six additional vegetations were found. Abnormal (greater than or equal to 2+) valvular regurgitation was present in 88% of patients. No patient with less than or equal to 1+ regurgitation (n = 8) died or required valve surgery for heart failure, but three of the eight patients did undergo surgery for mycotic aneurysm, recurrent embolism or paravalvular abscess. In patients without embolism before echocardiography, there was a trend toward a greater incidence of subsequent embolism in those with vegetations greater than 10 mm in size (26% [8 of 31] compared with 11% [2 of 18] with vegetations less than or equal to 10 mm) (p = 0.19). By multivariate analysis, risk factors for in-hospital death (n = 7) were an infected prosthetic valve (p less than 0.007), systemic embolism (p less than 0.02) and infection with Staphylococcus aureus (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of prosthetic valve endocarditis by 64-row multidetector computed tomography

Two patients with prosthetic aortic valves--one bioprosthetic and one mechanical--presented with bacteremia and underwent evaluation for infective prosthetic valve endocarditis. Multidetector computed tomography (MDCT) imaging demonstrated vegetations on both prosthetic valves confirmed by transesophageal echocardiography. Based on the MDCT coronary artery assessment, neither patient underwent pre-operative invasive coronary angiography. Both patients underwent surgical treatment without complication. In conclusion, this report demonstrates that MDCT can, in some cases, accurately image vegetations on prosthetic aortic valves in infective endocarditis.