Mitral valve repair for infective endocarditis

OBJECTIVE: This study investigated the feasibility of mitral valve (MV) repair in patients with active or healed infective endocarditis (IE) with mitral regurgitation and evaluated effects on left ventricular (LV) function and structure. METHODS: Subjects comprised 19 patients who underwent MV operations for IE between December 2004 and September 2007. MV repair was performed for acute IE in 10 of 15 patients (67%) and for healed IE in 4 of 4 patients (100%). RESULTS: No early or late postoperative deaths were encountered. One patient underwent redo MV repair owing to severe mitral regurgitation 1 month postoperatively. Postoperative echocardiography after MV repair demonstrated less than trivial (acute IE in seven, healed IE in three) or mild (acute IE in three, healed IE in one) mitral regurgitation. In patients with MV replacement, the postoperative left atrial dimension (LAD) was decreased (51.5 +/- 39.2 vs. 39.2 +/- 1.9 mm, P = 0.007); however LV end-diastolic dimension (LVDD) and LV end-systolic dimension were unchanged. In patients with MV repair, LVDD (57.5 +/- 6.5 vs. 46.0 +/- 5.6 mm, P < 0.001), LV end-systolic dimension (36.1 +/- 5.2 vs. 32.4 +/- 6.2 mm, P = 0.04), LAD (43.1 +/- 8.1 vs. 33.6 +/- 7.7 mm, P = 0.003) were reduced. Postoperative ejection fraction (55.3 +/- 13.5% vs. 41.8% +/- 10.0%, P = 0.03) and fraction shortening (30.1% +/- 9.2% vs. 20.7% +/- 5.5%, P = 0.03) were better in patients with MV repair than those with MV replacement. CONCLUSIONS: MV repair is feasible in patients with both active and healed IE. MV repair preserves better LV function and structure postoperatively.     

感染性心内膜炎导致栓塞的临床分析

目的探讨感染性心内膜炎(IE)导致栓塞发生的规律及其危险因素,以利于采取合理的防治措施。方法利用四川大学华西医院计算机病案管理系统检索1996年7月至2006年6月期间住院治疗的IE病例,按改良的Duke标准纳入研究对象381例。回顾性分析感染性心内膜炎发生栓塞的时间、部位以及与赘生物部位之间的关系;并根据是否发生栓塞将IE患者分为栓塞组和未栓塞组,采用logistic多元回归分析感染性心内膜炎发生栓塞的危险因素。结果IE栓塞发生率为15.5%(59/381),栓塞最常见的部位是脑动脉和脾动脉,分别占45.8%(27/59)和18.6%(11/59);栓塞发生于入院前后2周的比率高达71.2%(42/59);内科治疗中栓塞发生率为9.2%(16/174),明显高于手术后栓塞发生率1.8%(3/167,P<0.05);入院前栓塞发生率67.8%(40/59),入院后内外科治疗中栓塞发生率32.2%(19/59)。大赘生物(≥10mm)、赘生物培养阳性和高热等是感染性心内膜炎发生栓塞的危险因素(P<0.05,0.01)。结论栓塞易发生于感染活跃期。大赘生物(≥10mm)、赘生物培养阳性和高热是感染性心内膜炎发生栓塞的危险因素。     

Successful surgical treatment for infective endocarditis during pregnancy

We herein describe the case of a 31-year-old woman. In the 27th week of pregnancy, the patient was hospitalized because of fever and a lumbar backache. In the 29th week of pregnancy, she developed embolic symptom in her left lower limb. A cardiac murmur was detected, and a significant regurgitation of the mitral valve, along with a mobile vegetation at the posterior leaflet of the mitral valve, was detected by cardiac ultrasound examination, thus resulting in a diagnosis of infective endocarditis. At the time of diagnosis, the fetus was estimated to weigh 1400 g, and it was delivered by cesarian section, with a mitral valve repair being performed 4 days later. The mother did well and was discharged from the hospital after remission on the 30th hospital day. The infant was admitted to the NICU and was discharged from the hospital with good development and no complications at the age of 59 days, weighing 3066 g. Cardiac surgery under extracorporeal circulation in pregnant women is rare, and it is believed to have a high mortality rate for both the mothers and fetuses. On the other hand, the survival rate of low birth weight infants has improved as a consequence of progress in neonatal care. We herein report a case of mitral valve repair in the second trimester with a good outcome for both the mother and the infant.     

人工机械瓣膜替换术后晚期感染性心内膜炎

瓣膜替换术做心脏瓣膜病变确切可行的治疗方法，已被广泛应用，术后并发症也随之而来，我院1990年1月到1994年8月共为123例病人行人工机械瓣膜替换，术后晚期（指术后二个月以后）发生感染心内膜炎5例，发生率为4．07％，现报告如下。     

二尖瓣修复术治疗感染性心内膜炎所致二尖瓣反流患者

目的探讨二尖瓣修复及置换术对感染性心内膜炎所致二尖瓣反流患者的疗效。 方法选取2014年1月至2016年1月于淄博市中心医院就诊的126例感染性心内膜炎所致二尖瓣反流患者为研究对象,根据治疗过程中手术方式不同分为研究组和对照组（各63例）,研究组患者采取二尖瓣修复术进行治疗,对照组患者采取二尖瓣置换术进行治疗。详细记录入组患者的气管插管时间、入住重症加强护理病房（ICU）时间、感染发生率、手术患者病死率、住院天数、住院花费等;记录患者心脏超声检查结果：左心室射血分数、左心室舒张末期直径、左心室收缩末期直径、左心房直径及二尖瓣反流得分,并记录随访指标。 结果与对照组患者相比,研究组患者气管插管时间[（16.48 ± 8.06）h]、入住ICU时间[（2.12 ± 0.86）h]、术后病死率（1.59%）、住院时间[（22.46 ± 10.34）d]、栓塞发生率（4.76%）以及住院花费[（10.63 ± 3.57）万元]差异均有统计学意义（t = 1.35、P = 0.04,t = 3.68、P = 0.02,χ² = 4.67、P = 0.01,t = 4.03、P = 0.01,χ² = 1.69、P = 0.04,t = 3.06、P = 0.03）;研究组患者术后左心室射血分数[（49.06 ± 10.24）%]、左心房直径[（43.25 ± 8.98）mm]和二尖瓣反流得分[（1.12 ± 0.31）分]均小于对照组患者,左心室舒张末期直径[（52.46 ± 7.42）mm]和左心室收缩末期直径[（39.70 ± 8.09）mm]均大于对照组患者,差异均有统计学意义（t = 1.23、2.84、3.89、1.34、2.01,P = 0.04、0.02、0.01、0.03、0.02）。随访显示,研究组患者左心室射血分数[（61.38 ± 8.61）%]大于对照组患者（t = 5.31、P = 0.01）,左心室舒张末期直径[（48.69 ± 9.57）mm]和随访病死率（4.76%）均小于对照组,差异有统计学意义（t = 3.24、P = 0.02,χ² = 2.91,P = 0.03）。单因素方差分析显示入住ICU时间、插管时间和心功能衰竭史均为感染性心内膜炎患者手术死亡危险因素（t = 2.34、P = 0.01,t = 1.09、P = 0.03,χ² = 1.61、P = 0.02）。 结论二尖瓣修复术对感染性心内膜炎所致二尖瓣反流疗效和预后较好,能够缩短患者住院时间和降低入院费用。     

Pulmonary valve neocuspidisation with glutaraldehyde-treated autologous pericardium—A novel technique in pulmonary valve endocarditis

Infective endocarditis (IE) is a serious condition leading to heart failure, persistent sepsis. The management of IE involving valve is mainly excision of the infected valve and replacement with a heart valve; which are also at the risk of prosthetic valve endocarditis. Hence repair of the valve with autologous pericardium is much more physiological. We had a 20-year-old male presented with features of heart failure and high-grade fever not responding to optimum medical management. Two-dimensional echocardiogram revealed vegetation on pulmonary valve cusps with the erosion of the left and right cusps. Neo cusps with autologous pericardium offered good hemodynamics with trivial regurgitation. The patient is doing well with normal pulmonary valve function 3 months after surgery. This technique is reliable, economic, and easily reproducible.     

Emergency valve surgery for infective endocarditis complicated by acute intracranial hemorrhage: A case report

IntroductionOptimal timing of surgical treatment for infective endocarditis (IE) complicated by intracranial hemorrhage remains controversial.Presentation of caseA 43-year-old man with IE received appropriate antibiotic therapy but had recurrence of cerebral infarction and intracranial hemorrhage (ICH). Emergency valve surgery was performed 2 days after ICH onset because of heart failure and recurrence of cerebral complications. Postoperatively, he showed no neurologic symptoms; neuroimaging showed no enlargement of ICH.DiscussionPostoperative risk of neurologic deterioration may be relatively lower than previously thought in patients with IE who undergo surgery within 1 month after ICH onset.ConclusionsEmergency surgery in patients with ICH is justified in cases of multiple indications for such small ICH. Further evaluation regarding the risk of subsequent hemorrhage in patients with ICH who require emergency valve surgery is warranted.     

Extracardiac aneurysm of the interleaflet triangle above the aortic-mitral curtain due to infective endocarditis of the bicuspid aortic valve

A previously healthy 33-year-old man presented to our hospital with fever, left hemiparalysis, motor aphasia, and clouding of consciousness. Echocardiography revealed vegetation attached to the bicuspid aortic valve as well as an aneurysm originating below the annulus. Head computed tomography showed multiple infarctions. Under the diagnosis of infective endocarditis and perivalvular aneurysm, operation was performed because of the risk of further embolization. Operative findings showed an extracardiac aneurysm of the interleaflet triangle above the aortic-mitral curtain. Because there was no sign of active inflammation, the orifice was closed with an autologous pericardial patch, and the aortic valve was replaced with a mechanical valve. We should be aware of extracardiac aneurysm of the interleaflet triangle when dealing with infective endocarditis, which should be operated as soon as it is found because of the risk for extracardiac aneurysmal rupture.     

感染性心内膜炎的治疗

回顾分析１９９１～１９９５年间２３例感染性心内膜炎（ＩＥ）治疗经验。本组均使用过多种抗生素，ＩＥ未能控制。其中８例于感染活动期行手术治疗；１３例于感染未完全获得控制时行手术治疗；２例心脏直视手术后发生霉菌性心内膜炎，经抗霉菌药物治疗无效，改用大蒜素治疗，效果满意。本组２１例施行手术治疗者无手术死亡，术后随访无复发病例。结论：感染性心内膜炎即使血培养阳性，亦应在大剂量有效抗生素保护下尽早手术。早期诊断、及时手术是控制感染、降低死亡率的主要措施     

Surgical treatment of right-sided infective endocarditis

Objective

Right-sided infective endocarditis is increasing because of increasing prevalence of predisposing conditions, and the role and outcomes of surgery are unclear. We therefore investigated the surgical outcomes for right-sided infective endocarditis.

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。     

Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh stentless bioprosthesis

OBJECTIVE: We investigated outcomes after surgical therapy in patients with active infective endocarditis (AIE) with regard to survival in relation to surgical urgency, valve position, number of valves implanted and abscess formation. We aimed to identify independent risk factors for early mortality. METHODS AND RESULTS: Two hundred and fifty-five patients received Shelhigh bioprostheses between February 2000 and March 2007. A total of 74.1% had native and 25.9% prosthetic AIE. Surgery was regarded as urgent in 57.3% and as an emergency procedure in 38.4%. There was a highly significant difference in survival rate between patients who were operated on urgently versus in an emergency (p<0.0001), between single and double valve replacement (p=0.0206) and between patients with and without abscess formation (p=0.0245). There were two cases of early reinfection (0.78%) and six of late reinfection (2.35%) leading to re-operation. CONCLUSIONS: The survival of patients differs significantly in dependence on their surgical urgency. Better outcome could have been achieved if patients had been referred earlier for surgery and operated upon before heart failure or septic shock developed. Long-term survival was better in patients without abscess formation. The low reinfection rate of Shelhigh bioprostheses in AIE is promising and the early and mid-term results achieved need to be verified in the long-term course.     

Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium

Objective

We had previously reported the short-term results of the aortic valve neocuspidization (AVNeo) procedure. We have now evaluated the midterm results with the longest follow-up of 118 months.

感染性心内膜炎患者二尖瓣置换和成型术的效果

目的比较感染性心内膜炎患者行二尖瓣置换和成型手术的临床特点和转归。方法回顾性分析2013年1月至2016年12月在北京协和医院行手术治疗的、累及二尖瓣的感染性心内膜炎患者55例,男24例,女31例,年龄19～77岁,ASAⅡ-Ⅳ级,根据患者所行手术分为两组:二尖瓣置换术组(Z组,n=15)和二尖瓣成型术组(C组,n=40)。比较两组致病菌、临床表现、超声心动图表现、是否入住ICU、住院时间、术后并发症等。结果链球菌是感染性心内膜炎最常见的病原菌,发热、新出现的心脏杂音和贫血是最常见的临床表现。Z组贫血、心力衰竭、术后入ICU比例明显高于C组(P 0.05)。两组超声心动图表现、住院时间和术后并发症差异无统计学意义。结论对于有手术指征的感染性心内膜炎患者,合理选择手术方式可以改善患者预后。     

溶血隐秘杆菌致感染性心内膜炎一例

患者女,26岁,近4个月来反复出现发热,体温最高39.5℃,伴畏寒、寒战、乏力,发热时有关节疼痛,无胸闷、憋气等不适,于2012年6月20日来浙江省人民医院就诊.入院查体:体温38℃,心率98次/min,呼吸19次/min,血压98/58 mm Hg(1 mm Hg =0.133 kPa).精神欠佳,慢性病容,口唇无发绀,颈静脉无怒张.双肺呼吸音清,未闻及干湿性啰音.心律齐,心前区可及3/6级收缩期杂音,余未见明显异常.6月20日查红细胞沉降率(ESR)60 mm/1 h;C-反应蛋白(CRP)79.5 mg/L;血常规:白细胞5.16×109/L,中性粒细胞0.821,血红蛋白90g/L;并行血培养检查,次日显示阳性,经鉴定为溶血隐秘杆菌.用纸片扩散法检测细菌耐药性:菌株对青霉素G、头孢唑啉、头孢他啶、庆大霉素、氯霉素、替考拉宁均敏感,对红霉素耐药.     

感染性心内膜炎瓣膜损害的手术治疗

报告２３例感染性心内膜炎瓣膜损害的手术治疗。在体外循环下行机械瓣置换术１６例１９个瓣膜，行瓣膜成形术７例８个瓣膜，同时矫治先天性心脏病１０例。结果：死亡３例，随访中死亡１例。结论：在心内膜炎致瓣膜损害后手术治疗是积极有效的，术中应尽量修补保存自身瓣膜，术后必须积极预防和治疗并发症。