Gillinov A Marc, Faber Christiano N, Sabik Joseph F, Pettersson Gosta, Griffin Brian P, Gordon Steven M, Hayek Emil, Di Paola Linda M, Cosgrove Delos M, Blackstone Eugene H
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
Ann Thorac Surg. 2002 Jun;73(6):1813-6. doi: 10.1016/s0003-4975(02)03551-8.
Native valve endocarditis is frequently managed with antibiotics alone, but prosthetic valve endocarditis usually requires an early operation. What is the best treatment of endocarditis after mitral valve repair?
From 1986 to 2000, 22 patients were treated for endocarditis affecting a previously repaired mitral valve. Causes of mitral valve dysfunction that led to repair were degenerative (11 patients), ischemic (5 patients), endocarditic (3 patients), rheumatic (2 patients), and functional (1 patient). Endocarditis was active in 21 patients and healed in 1. Interval from initial mitral valve repair to onset of endocarditis ranged from 1 week to 10.3 years (median, 6 months). Pathology included leaflet vegetation (15), annuloplasty vegetation (4), leaflet perforation (5), and abscess (3). Mean follow-up was 3.9 +/- 3.3 years.
Fifteen patients underwent repeat mitral valve operations with freedom from mitral valve reoperation of 65%, 41%, and 26% at 30 days, 1 year, and 5 years after onset of endocarditis. After a high early hazard, risk of reoperation fell to 10.8% per year. Seven patients, all with a leaflet vegetation, were treated with antibiotics alone. Antibiotics eradicated infection in all; however all had mitral regurgitation 2+ to 4+. Survival was 96%, 74%, and 68% at 30 days, 1 year, and 5 years. Endocarditis recurred in 1 patient (92% free of event).
Most patients that have endocarditis develop after mitral valve repair require reoperation. However if infection is limited to a leaflet, early reoperation may be unnecessary because antibiotics alone can eradicate infection.
自体瓣膜心内膜炎通常仅用抗生素治疗，但人工瓣膜心内膜炎通常需要早期手术。二尖瓣修复术后的心内膜炎最佳治疗方法是什么？
1986年至2000年，22例患者因影响先前修复的二尖瓣的心内膜炎接受治疗。导致二尖瓣修复的二尖瓣功能障碍原因包括退行性病变（11例患者）、缺血性（5例患者）、心内膜炎（3例患者）、风湿性（2例患者）和功能性（1例患者）。21例患者的心内膜炎处于活动期，1例已愈合。从最初二尖瓣修复到心内膜炎发作的间隔时间为1周至10.3年（中位数为6个月）。病理表现包括瓣叶赘生物（15例）、瓣环成形术赘生物（4例）、瓣叶穿孔（5例）和脓肿（3例）。平均随访时间为3.9±3.3年。
15例患者接受了二尖瓣再次手术，心内膜炎发作后30天、1年和5年二尖瓣再次手术的免再手术率分别为65%、41%和26%。在早期高风险期之后，再次手术风险降至每年10.8%。7例均有瓣叶赘生物的患者仅接受了抗生素治疗。抗生素根除了所有患者的感染；然而，所有患者均有2+至4+的二尖瓣反流。30天、1年和5年的生存率分别为96%、74%和68%。1例患者心内膜炎复发（无事件生存率为92%）。
大多数二尖瓣修复术后发生心内膜炎的患者需要再次手术。然而，如果感染仅限于瓣叶，早期再次手术可能不必要，因为仅用抗生素就能根除感染。
