Birk Einat, Sharoni Erez, Dagan Ovadia, Gelber Oscar, Georghiou Georgios P, Vidne Bernardo A, Erez Eldad
Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.
J Heart Valve Dis. 2004 Jan;13(1):73-7.
The authors' experience is reported of aortic valve replacement (AVR) using the pulmonary autograft in patients with active aortic valve endocarditis, including an urgent Ross procedure in infants with the acute condition.
Nine patients aged between 8 months and 38 years, with a diagnosis of aortic valve endocarditis, have undergone AVR using the Ross procedure at the authors' institution since October 1997. The diagnosis was established by clinical and echocardiographic findings. Indications for surgery were severe aortic insufficiency and congestive heart failure in all patients, with the addition of thromboembolic events (n = 3), persistent hyperpyrexia (n = 3) and vegetations (n = 5). Four infants with no history of congenital cardiac malformation underwent urgent surgery because of acute bacterial endocarditis and rapid hemodynamic deterioration. Blood cultures were positive for Streptococcus pneumoniae in three patients, and Kingella kingi and Staphylococcus aureus in one patient each. Four patients were culture-negative. All patients were treated with intravenous antibiotics for four to six weeks postoperatively.
There were no perioperative or late deaths, and no recurrent endocarditis at the implanted valves. Echocardiographic evaluation at discharge showed trivial to mild aortic insufficiency, with no stenosis at the left ventricular outflow tract. Similar findings were found across the right ventricular outflow tract. At follow up (range: 4 months to 5.5 years), none of the patients showed progression of aortic valve insufficiency or developed stenosis; three had mild and moderate homograft stenosis (Doppler gradient 20-40 mmHg), and all children had moderate homograft insufficiency.
The Ross procedure is an excellent therapeutic option for active aortic valve endocarditis in young patients, and demonstrates low morbidity and mortality. Early surgery may be indicated in patients with acute aortic valve endocarditis because of the rapidly progressive nature of this disease.
本文报告了作者使用自体肺动脉瓣进行主动脉瓣置换术（AVR）治疗活动性主动脉瓣心内膜炎患者的经验，包括对患有急性病症的婴儿进行紧急罗斯手术。
自1997年10月以来，9例年龄在8个月至38岁之间、诊断为主动脉瓣心内膜炎的患者在作者所在机构接受了罗斯手术进行AVR。诊断通过临床和超声心动图检查结果确定。所有患者的手术指征均为严重主动脉瓣关闭不全和充血性心力衰竭，另外还有3例发生血栓栓塞事件、3例持续高热、5例有赘生物。4例无先天性心脏畸形病史的婴儿因急性细菌性心内膜炎和快速血流动力学恶化接受了紧急手术。3例患者血培养肺炎链球菌阳性，1例患者血培养金氏杆菌阳性，1例患者血培养金黄色葡萄球菌阳性。4例患者血培养阴性。所有患者术后均接受了4至6周的静脉抗生素治疗。
围手术期及晚期均无死亡病例，植入瓣膜处无复发性心内膜炎。出院时的超声心动图评估显示主动脉瓣关闭不全为轻度至中度，左心室流出道无狭窄。右心室流出道也有类似表现。随访（范围：4个月至5.5年）时，所有患者均未出现主动脉瓣关闭不全进展或出现狭窄；3例有轻度和中度同种异体瓣膜狭窄（多普勒压差20 - 40 mmHg），所有儿童均有中度同种异体瓣膜关闭不全。
罗斯手术是年轻患者活动性主动脉瓣心内膜炎的一种极佳治疗选择，且发病率和死亡率较低。由于急性主动脉瓣心内膜炎病情进展迅速，对于此类患者可能需要早期手术。
