Bahl V K, Vasan R S, Jain P, Shrivastava S
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.
Int J Cardiol. 1992 May;35(2):187-93. doi: 10.1016/0167-5273(92)90176-4.
We studied retrospectively 23 consecutive patients seen at our centre with right heart endocarditis. None of the patients had a history of intravenous drug abuse. All patients were found to have underlying congenital heart disease as a predisposing factor, of which ventricular septal defect (26%) and Fallot's tetralogy (26%) were the commonest. Postoperative endocarditis (26%) also constituted an important clinical subset. Fever (100%) and predominant pulmonary symptoms (69.5%) were the important presenting features. Congestive heart failure was present in 15 patients (65.2%) and predicted an adverse in-hospital outcome. Both the pulmonary and the tricuspid valves were affected equally with presence of vegetations at multiple sites in 10 patients (43.4%). Seven patients (30%) also had concomitant left-sided endocarditis. Medical therapy alone was successful in 15 patients (68.1%) with an overall in-hospital mortality of 31.8%. Five of 6 patients with postoperative endocarditis died, signifying an ominous prognosis of this subgroup when treated medically. The clinical spectrum of right-sided endocarditis in our country differs from the West. The frequent presence of underlying congenital heart disease, the rarity of drug abuse as a predisposing factor, equal involvement of the tricuspid and pulmonary valves and a greater incidence of congestive heart failure are some of these differences.
我们对在我们中心就诊的23例连续性右心内膜炎患者进行了回顾性研究。所有患者均无静脉药物滥用史。所有患者均被发现有潜在的先天性心脏病作为易感因素，其中室间隔缺损（26%）和法洛四联症（26%）最为常见。术后心内膜炎（26%）也是一个重要的临床亚组。发热（100%）和主要的肺部症状（69.5%）是重要的临床表现。15例患者（65.2%）出现充血性心力衰竭，提示住院预后不良。肺动脉瓣和三尖瓣受影响程度相同，10例患者（43.4%）在多个部位存在赘生物。7例患者（30%）还合并左侧心内膜炎。仅药物治疗15例患者成功（68.1%），总体住院死亡率为31.8%。6例术后心内膜炎患者中有5例死亡，表明该亚组药物治疗预后不佳。我国右侧心内膜炎的临床谱与西方不同。潜在先天性心脏病的频繁存在、药物滥用作为易感因素的罕见性、三尖瓣和肺动脉瓣同等受累以及充血性心力衰竭的更高发病率都是这些差异的一部分。
