Haldar Saptarsi M, O'Gara Patrick T
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Nat Clin Pract Cardiovasc Med. 2006 Jun;3(6):310-7. doi: 10.1038/ncpcardio0535.
Despite advances in antimicrobial therapy, diagnostic imaging and cardiac surgery, infective endocarditis (IE) remains challenging clinically and is associated with high morbidity and mortality. Diagnosis relies on several factors: initial clinical suspicion, microbiological data and echocardiographic findings. The use of an integrated diagnostic schema, such as the modified Duke criteria, is useful. Transthoracic or transesophageal echocardiography should be performed promptly for all suspected IE cases. Although the choice of investigation might be influenced by availability, the approach to imaging should be tailored to the individual's clinical situation. Promptly administered intravenous antimicrobial therapy is essential, while the use of antiplatelet or antithrombin therapy to prevent embolic complications is not supported by clinical data. Deciding whether to undertake cardiac surgery for the treatment of IE can be extremely difficult. The principal indications are the development of heart failure from acute, severe aortic or mitral regurgitation, or perivalvular extension of infection. The timing of surgery following central nervous system embolization is problematic because of the risk of hemorrhagic transformation. Prophylactic surgery to prevent embolization is currently advocated only for the management of large, mobile vegetations, when undertaken at centers performing high volumes of heart valve surgery. In this review, we describe diagnostic approaches for IE, particularly echocardiography, and provide recommendations for treatment, paying particular attention to surgery in the acute setting.
尽管在抗菌治疗、诊断性影像学检查和心脏外科手术方面取得了进展，但感染性心内膜炎（IE）在临床上仍然具有挑战性，且与高发病率和死亡率相关。诊断依赖于几个因素：初始临床怀疑、微生物学数据和超声心动图检查结果。使用综合诊断模式，如改良的杜克标准，是有用的。对于所有疑似IE病例，应立即进行经胸或经食管超声心动图检查。尽管检查方法的选择可能会受到可用性的影响，但影像学检查方法应根据个体的临床情况进行调整。及时给予静脉抗菌治疗至关重要，而临床数据并不支持使用抗血小板或抗凝血酶治疗来预防栓塞并发症。决定是否进行心脏手术治疗IE可能极其困难。主要指征是急性、严重主动脉或二尖瓣反流导致心力衰竭的发生，或感染的瓣周扩展。中枢神经系统栓塞后手术时机存在问题，因为有出血性转化的风险。目前仅在进行大量心脏瓣膜手术的中心，对于处理大型、活动的赘生物时，才提倡预防性手术以防止栓塞。在本综述中，我们描述了IE的诊断方法，尤其是超声心动图检查，并提供治疗建议，特别关注急性情况下的手术治疗。
