右心瓣膜感染性心内膜炎的外科治疗

目的：总结右心系统瓣膜心内膜炎的特点和手术处理经验。方法：回顾性分析右心系统瓣膜感染性心内膜炎１７例，其侵犯三尖瓣６例、肺动脉瓣４例，同时侵犯三尖瓣＋肺动脉瓣３例，肺动脉瓣＋主动脉瓣３例，主动脉瓣、二尖瓣、三尖瓣与肺动脉瓣同时受累１例。合并心脏畸形１４例，室间隔缺损修补术后、主动脉窦瘤破裂修补术后、起博器安置术后各１例。施行三尖瓣瓣膜游离缘或瓣膜赘生物切除直接缝合５例、三尖瓣瓣膜赘生物切除用自体心包片修补２例、部分瓣叶和瓣下结构切除缝合瓣叶并行人工腱索成形术１例，施行三尖瓣置换术２例；单纯行肺动脉瓣瓣叶赘生物切除４例，部分肺动脉瓣切除用自体心包片瓣叶成形术６例，切除肺动脉瓣用自体心包瓣置换１例。结果：术后早期死亡２例，病死率为１２％，术后早期并发急性肾功能不全３例，肝功能不全１例。术后随访５个月～１８年，平均随

Surgical intervention of right-sided infective endocarditis

Objective To summarize the experience of surgical treatment of right sided infective endocarditis. Methods In this series of 17 cases, 6 patients have involvement of tricuspid valve, 4 pulmonary valve, 3 tricuspid valve and pulmonary valve, 3 pulmonary valve and aortic valve, 1 tricuspid valve, pulmonary valve, aortic valve and mitral valve. Congenital cardiac lesions were found in 14 cases. Tricuspid valve repair or reconstruction was performed in 8 cases, tricuspid valve replacement in 2, pulmonary valve repair in 10, pulmonary valve replacement by autologous pericardium in 1. Results There were 2 early postoperative deaths giving an overall hospital mortality of 12%. Follow up of 5 months to 18 years, 1 had recurrent aortic valve endocarditis and 1 residual VSD. Conclusion Surgical therapy for right sided infective endocarditis can completely eradicate lesions and correct the associated hemodynamic derangement.