Rohmann S, Seifert T, Erbel R, Jakob H, Mohr-Kahaly S, Makowski T, Görge G, Oelert H, Meyer J
Division of Cardiothoracic and Vascular Surgery, University of Mainz, FRG.
Thorac Cardiovasc Surg. 1991 Oct;39(5):273-80. doi: 10.1055/s-2007-1019985.
The object of the study was to follow patients with endocarditis-associated abscesses in order to evaluate the clinical outcome with and without surgical intervention. Transesophageal echocardiography successfully displayed the location and extent of abscess cavities in 14 patients (group A) with aortic valve endocarditis. The infective process was limited to the perivalvular tissue in two, extended into the ascending aorta in six, and included the interventricular septum, the right ventricular outflow tract, interatrial septum, and/or mitral valve annulus in six patients. The complication rate was significantly higher in group A than in group B, which consisted of 27 patients with proven signs of endocarditis but without endocarditis-associated abscesses. The complication rates were embolic events 64.3% in group A vs 29.6% in group B, need for surgery in 64.3% vs 18.5%, and death in 50.0% vs 3.7%, respectively. The duration of fever--as a marker of an active infective process--before diagnosis and the onset of adequate treatment was significantly higher in group A than in group B (46.7 +/- 8.4 days vs 7.7 +/- 2.6 days). Organisms were isolated in 71.4% in group A and in all patients of group B. Streptococcal infections were noted in A in 54.5% vs 44.4% in B., staphylococcal in 27.3% vs 40.7%. Initial surgical repair in 9 of 14 patients in A (64.3%) included nine aortic valve and one mitral valve prosthesis implantations, two aortic valve-annulus reconstructive procedures, one dacron patch closure, and three partial resections of the aorta ascendens with end-to-end anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是对患有心内膜炎相关脓肿的患者进行随访,以评估有无手术干预的临床结局。经食管超声心动图成功显示了14例主动脉瓣心内膜炎患者(A组)脓肿腔的位置和范围。感染过程局限于瓣周组织的有2例,扩展至升主动脉的有6例,累及室间隔、右心室流出道、房间隔和/或二尖瓣环的有6例。A组的并发症发生率显著高于B组,B组由27例有明确心内膜炎体征但无心内膜炎相关脓肿的患者组成。并发症发生率分别为:A组栓塞事件为64.3%,B组为29.6%;A组需要手术的比例为64.3%,B组为18.5%;A组死亡率为50.0%,B组为3.7%。作为活动性感染过程指标的发热持续时间,在诊断和开始充分治疗前,A组显著高于B组(46.7±8.4天 vs 7.7±2.6天)。A组71.4%的患者分离出病原体,B组所有患者均分离出病原体。A组链球菌感染占54.5%,B组占44.4%;葡萄球菌感染A组占27.3%,B组占40.7%。A组14例患者中有9例(64.3%)进行了初次手术修复,包括9例主动脉瓣和1例二尖瓣假体植入、2例主动脉瓣环重建手术、1例涤纶补片修补术以及3例升主动脉部分切除端端吻合术。(摘要截断于250字)