Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
Eur J Cardiothorac Surg. 2010 Jan;37(1):159-62. doi: 10.1016/j.ejcts.2009.06.019. Epub 2009 Jul 28.
Bias against operating on patients with prosthetic valve endocarditis (PVE) who have multiple prostheses may preclude the use of life-saving valve replacement. We investigated the accuracy of the preoperative diagnosis of PVE in patients with both mitral and aortic prosthesis and the safety of single-valve replacement when only one valve seemed infected.
Patients with a diagnosis of active PVE who had mitral and aortic prosthesis in place were assessed. We looked at the methods for diagnosis, causative agents, indication for valve replacement, operative findings and outcome.
Twenty patients, who had both mitral and aortic prostheses and a diagnosis of PVE, were assessed. Streptococci and staphylococci caused 70% of cases. By means of echocardiography, the valves involved were: mitral (11 patients), aortic (six patients), and in three cases both prosthetic valves seemed infected. Surgery was undertaken in 17 patients (85%). The positive predictive value of transesophageal echocardiogram (TEE) for the preoperative diagnosis of the site of infection was 100%. In 13 patients, only the prosthetic valve that seemed infected was replaced. Four of these patients died within a week after the procedure. Nine patients survived the surgical procedure, completed a course of antimicrobial therapy and were followed up for 15.78 months (95% CI: 12.83-18.72). All were considered cured and relapses were not observed.
TEE allowed a diagnosis of site involvement that did correlate with the anatomic diagnosis obtained during the operation. This fact contributed to the management of patients and was of great help in guiding the surgical intervention. Echo-oriented single-valve replacement may be a safe strategy for patients with PVE and double prostheses.
对患有多个人工心脏瓣膜的心内膜炎（PVE）患者进行手术的偏见可能会妨碍挽救生命的瓣膜置换。我们研究了在二尖瓣和主动脉瓣均有假体的患者中 PVE 的术前诊断准确性，以及当只有一个瓣膜似乎受到感染时进行单瓣膜置换的安全性。
评估了诊断为活动性 PVE 且二尖瓣和主动脉瓣均有假体的患者。我们观察了诊断方法、病原体、瓣膜置换指征、手术发现和结果。
评估了 20 名患有二尖瓣和主动脉瓣且诊断为 PVE 的患者。链球菌和葡萄球菌引起了 70%的病例。通过超声心动图，受累瓣膜为：二尖瓣（11 例）、主动脉瓣（6 例），在 3 例中，两个人工瓣膜似乎都受到感染。17 例患者（85%）接受了手术。经食管超声心动图（TEE）对术前感染部位的诊断的阳性预测值为 100%。在 13 例患者中，仅更换了似乎受到感染的人工瓣膜。其中 4 例患者在手术后一周内死亡。9 例患者在手术中存活，完成了一个疗程的抗菌治疗，并随访了 15.78 个月（95%置信区间：12.83-18.72）。所有患者均被认为已治愈，且未观察到复发。
TEE 可做出与术中获得的解剖学诊断相吻合的受累部位诊断。这一事实有助于患者的管理，并在指导手术干预方面提供了很大帮助。针对 PVE 和双假体患者的基于回声的单瓣膜置换可能是一种安全的策略。
