感染性心内膜炎的外科治疗

1999年1月至2003年12月我院共收治15例感染性心内膜炎（IE）患者，经外科手术治疗，效果较好。     

感染性心内膜炎外科治疗60例

１９８０年３月以来,我们手术治疗感染性心内膜炎６０例,无手术死亡,现总结治疗体会如下：临床资料６０例中男４１例,女１９例。年龄７～５０岁,平均３０岁。其中先天性心脏病１９例,包括室间隔缺损１３例,主动脉窦瘤３例（２例窦瘤破裂,１例伴主动脉瓣狭窄关闭不...     

感染性心内膜炎外科治疗时机

目的 探讨感染性心内膜炎(IE)的手术治疗时机，以提高IE的治疗效果。方法 IE合并基础心脏病23例患者中，手术治疗13例，药物治疗10例；无基础心脏病15例患者(IE后引起心瓣膜损害13例，无心瓣膜损害2例)，手术治疗9例，药物治疗6例。结果 原有心脏病变基础上发生IE者，手术13例，全部治愈；药物保守治疗10例，死亡2例。IE后引起心瓣膜损害患者手术9例，治愈7例，好转2例；4例药物保守治疗好转2例，近期死亡2例，其中1例为金黄色葡萄球菌感染。手术患者中有栓塞史12例，发现赘生物21例，血培养阳性8例。所有手术患者均康复出院。随访3天一6个月，近期无感染复发，2例瓣膜成形的患者需再手术治疗，无死亡。3例急症手术患者治愈。药物治愈2例。结论 原有心脏病变基础上发生IE患者或IE引起心瓣膜损害患者，特别是金黄色葡萄球菌感染者应尽早手术，否则可增加病死率；对感染、心力衰竭难以控制、赘生物增大有脱落趋势或有多次栓塞史患者应急症手术。     

感染性心内膜炎的外科治疗

目的总结自身瓣膜感染性心内膜炎的外科治疗经验。方法 2000年1月至2008年6月上海交通大学医学院附属仁济医院收治感染性心内膜炎患者49例,男27例,女22例;年龄14~74岁,平均年龄44.2岁。基础疾病:先天性心脏病12例,包括室间隔缺损、右心室流出道狭窄、主动脉窦瘤和动脉导管未闭等;后天性心瓣膜病34例,包括风湿性二尖瓣病变、主动脉瓣病变和老年性心瓣膜退行性变等。不合并基础心脏疾病3例。所有患者均在低温体外循环下施行先天性心脏病矫治术和心瓣膜置换术;术中尽可能清除赘生物,对受侵犯的组织采用碘伏溶液多次擦洗,再用生理盐水彻底冲洗。术后给予抗生素治疗4~6周。结果围术期死亡2例(4.08%),1例因心力衰竭死亡,另1例因严重肺部感染死亡。术后2例患者持续发热,继续给予抗生素治疗2周后,体温渐趋平稳。随访35例(71.43%),随访时间4个月至6年,失访12例。1例室间隔缺损、三尖瓣赘生物患者手术后1个月再次发热,再次入院接受抗生素治疗后治愈。3例发生抗凝治疗并发症,出现牙龈或结膜出血、皮肤瘀斑、血尿、消化道出血,暂停抗凝治疗后好转。随访期间未见感染性心内膜炎复发。结论早期诊断、正确把握手术时机,药物与手术相结合是成功治疗感染性心内膜炎的关键。     

感染性心内膜炎的外科治疗

目的总结感染性心内膜炎(IE)外科治疗的临床经验。方法回顾性分析1998年6月至2005年12月收治的23例IE患者外科手术治疗的临床资料,其中先天性心脏病13例,风湿性心瓣膜病7例,原发性细菌性心内膜炎3例。术前16例行血液细菌培养,阳性7例。术前心功能分级(NYHA)级2例、级12例、级9例。行主动脉瓣置换术4例、二尖瓣置换术4例、主动脉瓣和二尖瓣双瓣膜置换术3例、主动脉瓣、二尖瓣、三尖瓣置换术2例;单纯心内分流修补术8例,主动脉瓣置换加心内分流修补术2例。术后应用足量的敏感抗生素4～6周。结果术后第5d和9d分别死亡2例,其中1例因全身肢端和多器官栓塞、脑出血死亡,1例因心脏骤停死亡。术后20例患者心功能恢复至～级,治愈出院;1例心功能级患者好转出院。术后随访19例,随访时间6个月至7.5年,18例心功能～级,1例心功能级;发生主动脉瓣瓣周漏2例,其中1例于术后3年自愈,1例随访2.6年,无任何自觉症状,心功能级。结论IE经外科手术治疗能取得较好的治疗效果。     

感染性心内膜炎及合并心内畸形的外科治疗

我科自 1980年 2月～ 1998年 12月收治了 15 7例感染性心内膜炎及合并心内畸形患者 ,现将诊断治疗的经验总结如下。1　临床资料与方法1.1　一般资料　本组共 15 7例 ,男 12 2例 ,女 35例。年龄13～ 6 8岁 ,平均年龄 36 .6岁。临床有高热和不规则发热 113例 ,栓塞和偏瘫 12例。胸骨左缘第 3～ 4肋间或心尖部可闻及 ～ 级舒张期或收缩期吹风样杂音。合并心内畸形者在相应听诊区有连续性或收缩期杂音。超声心动图示主动脉瓣关闭不全 94例 ,有赘生物 75例 ;二尖瓣关闭不全 42例 ,二尖瓣狭窄 12例 ,有赘生物 2 8例 ;肺动脉瓣有赘生物 3例 ;三尖…     

感染性心内膜炎的外科治疗

目的探讨感染性心内膜炎（IE）的外科手术治疗效果及围术期处理原则。方法回顾性分析2001年3月～2010年10月接受感染性心内膜炎手术治疗患者15例的临床资料。术前经超声心电图检查证实心内赘生物形成者15例。所有患者均经外科手术清除感染病灶及赘生物,并纠治瓣膜病变和心脏畸形,术前术后应用大剂量敏感抗生素。结果术后早期死亡1例（6.7%）,术后随访时间3～48月,随访14例（93.3%）,均无心内膜炎复发,心功能恢复I级12例,Ⅱ级2例。结论外科手术治疗感染性心内膜炎是一种有效的治疗方法。正确掌握手术时机,彻底清除感染病灶,恢复瓣膜功能以及围手术期应用有效抗生素是提高感染性心内膜炎治愈率的生要措施。     

先天性心脏病感染性心内膜炎的外科治疗

先天性心脏病感染性心内膜炎的外科治疗姚培炎，朱洪生，周嘉自１９８７年６月至１９９４年１０月我们手术治疗先天性心脏病（先心病）感染性心内膜炎病人２２例，疗效良好，无手术死亡率，报道于下：临床资料本组２２例中男１３例，女９例。年龄７～５８岁，平均２８岁。...     

复杂性感染性心内膜炎的外科治疗

目的评价瓣周脓肿、心肌脓肿以及瓣膜严重毁损等复杂性感染性心内膜炎手术治疗的近、远期疗效.方法回顾性分析1988年12月至2002年6月手术治疗的复杂性心内膜炎患者57例临床资料,均为原发性心内膜炎,其中感染侵犯主动脉瓣25例、二尖瓣16例、二尖瓣和主动脉瓣16例.术中发现瓣叶严重毁损32例、主动脉瓣周脓肿19例、主动脉根部环形脓肿导致左心室-主动脉连接破坏4例、二尖瓣后瓣环脓肿11例、心肌脓肿6例、瓣膜赘生物形成55例.脓肿清除后遗留残腔采用间断褥式缝合6例、自体心包片修补19例、牛心包片修补6例、聚四氟乙烯膨体补片修补4例;施行以带瓣管道作升主动脉根部替换和左、右冠状动脉移植术4例,主动脉瓣替换术21例,二尖瓣替换术16例,主动脉瓣及二尖瓣双瓣替换术16例.结果早期死亡6例(11%),死亡主要原因为低心输出量综合征、人造心脏瓣膜性心内膜炎和多脏器功能衰竭.随访4个月至14年,平均(5.93±0.20)年.晚期死亡5例,晚期主要并发症为人造瓣膜性心内膜炎.术后1年心功能恢复NYHA分组Ⅰ～Ⅱ级占96%(44/46);5年再手术免除率为(84±3)%,5年实际生存率为(61±9)%.结论复杂性心内膜炎局部组织破坏较多,应限期手术或急症手术,清创后残腔的处理是影响手术本身能否成功以及术后近、远期效果的关键.     

小儿感染性心内膜炎的诊断和外科治疗

感染性心内膜炎 (ＩＥ)的诊断和外科治疗得到越来越多的重视和研究 ,而小儿ＩＥ的诊断和外科治疗报道尚少。我们自 1992年 4月至 2 0 0 0年 4月手术治疗小儿ＩＥ 17例 ,治愈15例 ,死亡 2例。随访 14例 ,迄今无再发ＩＥ并取得满意的远期效果。现报告如下。资料和方法　 17例中男 13例 ,女 4例 ;年龄 1～ 14岁 ,平均 (8 6 5± 4 5 3)岁 ;体重 12～ 5 4ｋｇ,平均 (2 4 7± 8 6 2 )ｋｇ。临床症状为发热 15例 ,消瘦、乏力各 12例 ,食欲不振 10例 ,心衰 5例。查体除原发心脏体征外 ,肝、脾肿大 13例 ,双肺干湿性罗音 6例 ,1例心脏杂音出现变化…     

Surgery for infective valve endocarditis in children

Objective: Surgery for endocarditis in children is relatively uncommon. Our aim is to assess operative mortality, recurrent infection, re-operation and long-term survival rates following surgery for infective valve endocarditis in children. Patients: Sixteen consecutive children (ten female, six male, mean age 11.8 years, range 25 days–16 years) undergoing surgery between 1972 and 1999 in Southampton were studied. The aortic valve was affected in five, mitral in four, aortic and mitral in one, tricuspid in five and a pulmonary homograft in one patient. Prosthetic valve endocarditis was present in three. Twelve surgical interventions were emergency and four urgent. Indications for operation included cardiac failure in five, severe valvular dysfunction in nine, vegetations in nine, persistent sepsis in four and embolization in four patients. The offending micro-organism was identified in 13. Valve replacement was performed in 11 and excision of vegetations in two and excision of vegetations and repair in three. Follow-up was complete (mean 11.2 years, range 2 months to 26.3 years, total 179.5 patient years). Results: There was one operative death (6.2%) in a 25-day-old neonate who presented in a moribund condition. Endocarditis recurred in one patient (6.25%). Freedom from recurrent infection at 10 and 20 years was 100.0 and 87.5%. Seven surgical re-interventions were required in four (25.0%) patients with no operative mortality. Freedom from re-operation at 1, 5, 10 and 20 years, was 84.6, 76.1, 76.1 and 60.9%, respectively. Two patients died 15 and 23 years after their first operation. The cause of the late deaths was non-cardiac in the first and unknown in the other. Actuarial survival, including operative mortality, at 1, 15 and 20 years was 93.7, 93.7 and 78.1%. Conclusions: Surgery in children with infective valve endocarditis can be performed with low operative mortality. Although some patients may require re-operation, freedom from recurrent infection and long-term survival are satisfactory.     

Surgery for infective endocarditis: determinate factors in the outcome

AIM: The appropriate operative procedures for treatment of infective endocarditis (IE) are still controversial. The authors reviewed their own operative results focusing on preoperative risk factors, intraoperative findings and operative procedures. METHODS: The authors reviewed the cases of 40 adult patients who had undergone surgery since 1999. The mean age of patients was 58 years ranging from 31 to 78 including 30 males and 10 females. Thirty-three patients had native valve endocarditis (NVE) and the remaining seven patients had prosthetic valve endocarditis (PVE). Diseased lesions were located in the mitral valve (MV) in 21 patients, aortic valve in 15 and mitral plus aortic valves in four. Twenty-eight patients (70%) were operated on during the active phase of IE. Streptococcus, Staphyrococcus and Enterococcus species were predominant in the bacterial examination. RESULTS: Active vegetation was observed in 26 (65%) patients. Perforation of valve leaflets was observed in 11 (28%) cases. Changes of native MV leaflet were mild in 8 (40%) out of 20, which seemed to be reparable, while, changes of the native aortic valve leaflet were moderate to severe in 13 (87%) out of 15 patients. Valvular annuls were involved in the infection in 17 (43%) patients. Of the 33 NVE patients, prosthetic valve replacement was performed in 29 patients incduding 19 mitral and 15 aortic valves. MV plasty was performed in 4 patients. In seven PVE patients, prosthetic MV replacement was performed twice. In the aortic group, three patients underwent aortic root translocation, The Ross procedure and standard root replacement were performed respectively. Four patients died after surgery including one NVE case and three PVE cases. Three PVE patients who underwent aortic root translocation or the Ross procedure survived. The hospital mortality of NVE and PVE surgery was 3% and 43% (P<0.01), respectively. By univariant anlysis, there were no significant correlations between operative results and preoperative factors such as bacteria, infective phase, cardiac failure, renal failure, sepsis or brain morbidity. The only significant factor on hospital mortality was PVE. Three patients died of non-cardiac diseases during the follow-up period. CONCLUSION: Operative results of NVE were good after complete resection of infective sites including valve annulus. Both valve replacement and plasty were available for NVE patients. In PVE, new strategies are indispensable and aortic root translocation or the Ross procedure should be a treatment of choice.     

活动期感染性自然心内膜炎的外科治疗

目的　总结活动期感染性自然心内膜炎外科治疗的经验。方法　自 1996年 10月 1日至 2003年 12月 31日,阜外心血管病医院外科共手术治疗活动期感染性自然心内膜炎 54例。有明确感染诱因的 21例,先天性心内结构畸形 23例,风湿性瓣膜病 1例。术前心功能NYHA分级:Ⅰ级6例,Ⅱ级 12例,Ⅲ级 7例,Ⅳ级 29例。术前左心室舒张末径 ( 63±11 )mm。发病至手术间隔 8 ~629d(中位数 125d)。行主动脉瓣置换 25例,主动脉瓣及二尖瓣置换 15例,二尖瓣置换 6例,二尖瓣成形 3例,肺动脉瓣置换 1例,单纯心内分流修补 4例。术后应用足量敏感抗生素 6 ~8周。结果手术死亡 5例,死因均为感染,术后即失访 4例,手术死亡率 17% (9 /54)。14例 ( 26% )发生手术并发症。45例随访 6~67个月,平均(31±19)个月。术后心功能NYHA分级Ⅰ级 41例,Ⅱ级 3例,Ⅲ级 1例,左心室舒张末径 (52±8)mm。2例病人接受再次手术,术后康复;有再次手术指征但未手术者 3例。术后晚期意外死亡 1例,抗凝过量致颅内出血 1例。结论　活动期感染性自然心内膜炎经积极的外科治疗能够取得较好的治疗效果。     

单纯右心感染性心内膜炎的外科治疗

目的 总结分析单纯右心系统感染性心内膜炎的外科治疗及效果.方法 回顾性分析1994年1月至2009年2月接受手术治疗的单纯右心感染性心内膜炎患者28例的临床资料,其中男性18例,女性10例;年龄10～72岁,平均38岁;平均住院35.8 d.所有患者均以间断发热就诊.术前心功能不全(NYHAⅢ或Ⅳ级)14例,肺栓塞或肺炎25例,血培养阳性18例,超声证实心内赘生物形成27例.所有患者均在心肺转流下行赘生物清除、合并心脏畸形的矫治及三尖瓣手术,术后继续使用抗生素治疗2～3周.结果 术后1例患者二次开胸止血,2例患者因呼吸功能不全呼吸机辅助呼吸超过1周,3例发生肾功能不全,11例患者出院前超声示三尖瓣轻度或中度反流.1例患者术后因重度感染、多器官功能衰竭死亡,27例患者治愈出院.随访6个月～15年,患者心功能从术前的Ⅱ～Ⅳ级降到术后的Ⅰ～Ⅱ级,手术后心力衰竭症状明显改善;无复发病例.结论 外科手术可有效治疗由先天性心脏病或右心植入物引起的单纯右心感染性心内膜炎,并取得满意效果.     

Operative treatment of infective endocarditis in children

A retrospective review of 11 children, aged 2 months to 15 years, demonstrates the feasibility of surgical treatment for infective endocarditis in childhood. Except for one case of perinatal infection, in all instances the infective endocarditis was a complication of a congenital heart defect. As medical treatment was not successful, surgery was indicated. Debridement of infected tissue and repair of the congenital heart defect was performed. There were no septic complications postoperatively although 8 patients were operated upon during the active stage of infection. One 2-month-old child did not survive excision of an infected tricuspid valve. The follow-up period of 8 years to 5 months (median 39 months) showed a good haemodynamic result (NYHA class I) in the remaining 10 patients. This included 4 patients with prosthetic valves.     

感染性心内膜炎诊断和手术适应症的研究进展

感染性心内膜炎是一种严重威及生命的心血管疾病。早期明确诊断、早期手术治疗是治疗感染性心内膜炎的关键。适当的早期手术可以避免死亡和严重并发症,但手术的最佳时机仍不清楚。这需要临床工作者通过多学科合作来对早期手术的益处与风险进行权衡,以确保为患者提供早期手术的机会。目前,感染性心内膜炎早期手术治疗的主要适应症是:心力衰竭、不受控制的感染和预防栓塞。在这里,我们就感染性心内膜炎的诊断、抗菌治疗和手术治疗的适应症展开讨论。     

Surgical management of infective endocarditis in children.

Infective endocarditis occurs infrequently in the general pediatric population, occurring mostly in patients with congenital heart disease. This study reviews our surgical experience with infective endocarditis based on a policy of aggressive intervention, conservative operative debridement, and creative reconstruction options using pericardium and prosthetic heart valves. From 1982 to 1989, 16 patients, 3 weeks to 16 years of age, underwent 19 intracardiac operations for infective endocarditis therapy at Kosair Children's Hospital. Eight (42%) were for resection of vegetations alone; an additional 11 operations (58%) involved more extensive debridements requiring either valve replacement or valvuloplasty using pericardium for exclusion of an abscess cavity, closure of a fistula, or for valve repair. Operative mortality was 25% (4 patients) and related to preoperative disease severity. There was one late death. Offending organisms included Staphylococcus species (31%), Haemophilus influenzae (13%), pneumococcus (5%), gram-negative organisms (13%), and Candida (13%); no organism grew on culture in 25%. We conclude that aggressive surgical exploration in patients with infective endocarditis is indicated and often requires resection of vegetations alone. More extensive procedures should preserve as much valvular tissue as possible. Pericardium is useful for reconstruction after debridement.     

61例感染性心内膜炎的诊断与治疗总结

目的 探讨感染性心内膜炎的诊断与外科治疗特点,分析外科治疗对术后短、中期疗效.方法 回顾性分析1995年1月～2008年4月期间61例感染性心内膜炎患者接受手术治疗的临床资料,总结外科治疗经验.结果 术后早期死亡4例(6.6%),术后随访6月～13年.出院患者死亡5例,其他生存患者中心功能Ⅱ级43例,Ⅲ级9例.结论 早期明确诊断、选择合适的手术时机及内、外科综合治疗是感染性心内膜炎成功治疗的关键.