Shapira Nadiv, Merin Ofer, Rosenmann Eliezer, Dzigivker Ilia, Bitran Dan, Yinnon Amos M, Silberman Shuli
Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
Ann Thorac Surg. 2004 Nov;78(5):1623-9. doi: 10.1016/j.athoracsur.2004.05.052.
The diagnosis of infective endocarditis is usually made on the basis of clinical and laboratory criteria and may be confirmed by histologic examination or culture of excised valves. We tried to determine the incidence and significance of inflammatory changes in valves excised during operations for reasons other than infective endocarditis.
The charts and histopathology of all patients undergoing valve replacement during a 10-year period (1993-2002) were reviewed. A total of 868 patients underwent a total of 970 valve replacements during this period, of whom 11 patients (1.3%) were for endocarditis, with the remaining 857 (98.7%) for other indications. All excised valves were cultured and examined histologically for the presence of inflammatory infiltrates, vegetations, and microorganisms.
In 8 of 857 patients (0.9%), the histologic examination unexpectedly demonstrated an infiltrate suggestive of endocarditis. Blood and valve cultures, and serologic tests for Mycoplasma, Chlamydia, Legionella, Q fever, Brucella, Rickettsiae, VDRL, and Bartonella were negative in all but 1 patient, who was found to have Q fever. All received a prolonged course of antibiotics. Six patients had an uneventful recovery; 1 had intramyocardial abscesses and expired during cardiac reoperation; and 1 had recurrent fever and dehiscence of the aortic and mitral valve prostheses and after two cardiac reoperations remains in severe heart failure.
The presence of an unexpected inflammatory infiltrate in heart valves excised for reasons other than endocarditis may occur in 0.9% of such operations; these infiltrates could indicate presence of endocarditis. A microbial origin should be sought, and patients should receive empiric antibiotic treatment for endocarditis.
感染性心内膜炎的诊断通常基于临床和实验室标准，可通过切除瓣膜的组织学检查或培养来确诊。我们试图确定因非感染性心内膜炎原因接受手术切除的瓣膜中炎症改变的发生率及意义。
回顾了1993年至2002年这10年间所有接受瓣膜置换术患者的病历和组织病理学资料。在此期间，共有868例患者接受了970次瓣膜置换术，其中11例（1.3%）为心内膜炎患者，其余857例（98.7%）为其他适应证患者。所有切除的瓣膜均进行培养，并进行组织学检查，以确定是否存在炎症浸润、赘生物和微生物。
在857例患者中的8例（0.9%），组织学检查意外发现提示心内膜炎的浸润。除1例确诊为Q热的患者外，所有患者的血液和瓣膜培养以及支原体、衣原体、军团菌、Q热、布鲁氏菌、立克次体、性病研究实验室试验（VDRL）和巴尔通体的血清学检查均为阴性。所有患者均接受了长时间的抗生素治疗。6例患者恢复顺利；1例发生心肌脓肿，在再次心脏手术期间死亡；1例反复发热，主动脉和二尖瓣人工瓣膜裂开，两次心脏再次手术后仍处于严重心力衰竭状态。
因非心内膜炎原因切除的心脏瓣膜中意外出现炎症浸润的情况可能在0.9%的此类手术中发生；这些浸润可能提示心内膜炎的存在。应寻找微生物来源，患者应接受针对心内膜炎的经验性抗生素治疗。
