经导管封堵器置入术后迟发感染性心内膜炎临床特点分析

目的分析经导管封堵器置入术后迟发(术后≥6个月)感染性心内膜炎(IE)的临床特点。方法报道北京协和医院收治的1例封堵器置入术后8年发生IE的病例,并分析国内外数据库中经导管封堵器置入术后迟发IE的病例特点。结果北京协和医院1例23岁女性,房间隔缺损封堵术后8年出现发热,脑栓塞,超声心动图示封堵器左心房面赘生物,给予抗感染及手术移除封堵器。文献报道经导管封堵器置入术后迟发IE 16例(男10例/女6例),其中房间隔缺损封堵术后9例,卵圆孔未闭封堵术后3例,二尖瓣人工瓣瓣周漏封堵术后2例,动脉导管未闭封堵术后1例,室间隔缺损封堵术后1例。发生IE时间为封堵术后7个月~16年,发热和栓塞是最常见的临床表现。发生IE前有6例感染,3例行牙科治疗。血培养最常见细菌是金黄色葡萄球菌。14例行手术治疗,术中所见与术前超声心动图检查基本吻合,8例存在封堵器内皮化不全。结论经导管封堵器置入术后患者长期有IE的风险,特别是出现感染情况时,发生IE后多数需手术治疗。封堵器内皮化不全可能与封堵术后迟发IE相关。

Clinical features of late infective endocarditis after transcatheter implantation of closure device

Objective To analyze the clinical characteristics of late development(≥6 months)of infective endocarditis(IE)after transcatheter implantation of occluder device.Methods We reported a case of late infective endocarditis occurred 8 years after transcatheter closure in Peking Union Medical College Hospital and reviewed the late infective endocarditis cases after device closure reported in the literature.Results The patient is a 23-year-old female,and she underwent transcatheter closure of ostium secundum atrial septal defect with atrial septal occlude device 8 years ago.She presented with fever and cerebral embolism.Echocardiography showed a vegetation lining the left atrial disc of the closure device.The patient was treated with anti-infective therapy and surgical removal of prosthesis.Sixteen cases(10 males and 6 females)of late infective endocarditis after transcatheter device closure have been reported in the literature(9 atrial septal defect,3 patent foramen ovale,2 mitral valve artifi cial perivalvular leakage,1 patent ductus arteriosus and 1 ventricular septal defect).IE was occurred between 7 months and 16 years after transcatheter occlusion.Fever and embolism were common onset symptom.Six patients suff ered from infection and 3 underwent dental treatment before IE,and the most common bacterium in blood culture is staphylococcus aureus.14 cases underwent surgical operation,and the intraoperative findings were consistent with preoperative echocardiographic findings.There was incomplete endothelialization of the prosthesis in 8 patients.Conclusions The patients are at long-term risk of IE after transcatheter implantation of closure device,especially if they suffer from infection.Most patients need surgical procedures and incomplete device endothelialization may be the possible reason of late IE after transcatheter closure.