儿童感染性心内膜炎的外科治疗

目的：总结儿童感染性心内膜炎的外科治疗经验，以期掌握好手术时机及指征，提高手术成功率。方法：28例儿童心内膜炎病人，7例因急性心力衰竭、栓塞或严重败血症急诊手术；21例经抗生素治疗体温正常后择期手术。彻底清除赘生物后，同时行主动脉瓣瓣膜置换5例，主动脉根部拓宽、主动脉瓣瓣膜置换2例，室间隔缺损（室缺）修补5例，室缺修补、右室流出道疏通2例，室缺和佛氏窦瘤修补2例，室缺修补、主动脉瓣瓣膜置换2例，动脉导管缝扎3例，动脉导管缝扎、主动脉瓣瓣膜置换1例，二尖瓣瓣膜置换3例，二尖瓣瓣膜置换、左冠前降支取栓并搭桥1例，法洛四联症矫正、Rastelli手术和1例。同期行三尖瓣成形6例、肺动脉瓣成形7例。结果：手术死亡1例（3．6％），死亡原因为术后霉菌性感染不能控制、多器官功能衰竭。术后平均随访2．6年，心内膜炎复发2例，无远期死亡。结论：儿童感染性心内膜炎手术治疗的远期效果满意，其手术时机及指征的掌握对治疗效果至关重要。

Surgery for infective endocarditis in children

Objective: To provide an overview of surgical treatment of 28 children with infective endocarditis. Method: Twenty-eight consecutive children undergoing surgery were studied. The offending microorganism was identified in 16 cases. Seven surgical interventions were emergency due to acute heart failure, embolization and severe sepsis. Selective surgery was done in twenty-one due to primary intra-cardiac abnormalities, valvular dysfunction and vegetation after temperature was normal by antibiotic treatment. Aortic valve replacement (AVR) were performed in 5, AVR and enlarge of aortic root in 2, closure of ventricular septal defect (VSD) in 5, closure of VSD and enlargement of aortic root in 2, closure of VSD and repair of aneurysm of Valsalva in 2, closure of VSD and AVR in 2, suture of patent ductus arteriosus in 3, suture of patent ductus arteriosus and AVR in 1, mitral valve replacement in 3, mitral valve replacement and coronary artery bypass grafting in 1, total correction of tetralogy of Fallot in 1, and Rastelli in 1. Repair of tricuspid valvular defect in six and pulmonary valvular defect in seven. Results: There was one operative death (3.6%) in a 5-year-old boy for uncontrolled infection and multi-organ failure after re-operation, who suffered from fungous endocarditis and VSD recurrent after VSD repair. Two surgical re-interventions (7.2%) were required for endocarditis recurred and there was no death during the follow-up of three months to six years. Conclusion: Long-term survivals of surgery for infective endocarditis in children are satisfactory. The timing of surgery plays an important role in the operative results.