Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA.
Cardiovasc Pathol. 2011 Jan-Feb;20(1):26-35. doi: 10.1016/j.carpath.2009.09.006.
Few studies have documented the clinicopathological features of prosthetic valve endocarditis independently of native valve endocarditis.
Retrospective analysis of patients undergoing cardiac surgery for prosthetic valve endocarditis at our institution (1985-2004).
Medical records and microscopic slides were reviewed from 116 patients for demographics, infecting organisms, comorbidities, and pathologic features.
Patients were 12-86 years old (mean, 59 years). Among 122 valves, 64% were from men and 67% were purely regurgitant. Aortic prosthetic valve endocarditis frequently affected men (76%); mitral prosthetic valve endocarditis often affected women (62%). Embolization occurred in 35% and heart failure in 32%. Prevalent predisposing conditions were the prosthetic valve alone (43%) and diabetes mellitus (20%). Prosthetic valve endocarditis was aortic or mitral in 98% and was active in 70%. Annular abscess or paravalvular leak affected mechanical valves more frequently than bioprosthetic (89% vs. 65%; P=.001). Causative organisms (n=116) included Staphylococcus aureus (30%), coagulase-negative staphylococcus (22%), viridans streptococci (18%), enterococci (10%), other streptococci (8%), and other organisms (12%). S. aureus was the most prevalent cause of early-onset (38%) and late-onset (30%) prosthetic valve endocarditis. Coagulase-negative staphylococcus caused early-onset (31%) and most intermediate-onset (40%) disease and had a shorter median implantation-to-infection time than other organisms (6.5 vs. 61.3 months; P<.001). Viridans streptococci and enterococci primarily caused late-onset endocarditis. For active infections by cocci, most cases exhibited strong Gram staining, but four showed only strong Grocott methenamine silver staining.
Cocci accounted for 83% of infections. Early-onset prosthetic valve endocarditis was primarily staphylococcal, and late-onset prosthetic valve endocarditis resembled native valve endocarditis. Both Gram and Grocott methenamine silver stains were necessary to reliably identify organisms microscopically.
鲜有研究能独立于原生瓣膜心内膜炎之外，对人造瓣膜心内膜炎的临床病理特征进行记录。
对本机构（1985-2004 年）收治的行心脏手术治疗的人造瓣膜心内膜炎患者进行回顾性分析。
对 116 例患者的病历和显微镜切片进行回顾，以了解人口统计学资料、感染病原体、并存疾病和病理特征。
患者年龄为 12-86 岁（平均 59 岁）。122 个瓣膜中，64%来自男性，67%为单纯反流性。主动脉人造瓣膜心内膜炎常累及男性（76%），二尖瓣人造瓣膜心内膜炎常累及女性（62%）。35%的患者发生栓塞，32%发生心力衰竭。最常见的易患条件是单独使用人造瓣膜（43%）和糖尿病（20%）。98%的人造瓣膜心内膜炎为主动脉瓣或二尖瓣，70%为活动性病变。瓣环脓肿或瓣周漏更常发生于机械瓣膜而非生物瓣膜（89%比 65%；P=.001）。116 例病原体（n=116）包括金黄色葡萄球菌（30%）、凝固酶阴性葡萄球菌（22%）、草绿色链球菌（18%）、肠球菌（10%）、其他链球菌（8%）和其他病原体（12%）。金黄色葡萄球菌是早发性（38%）和迟发性（30%）人造瓣膜心内膜炎的最常见原因。凝固酶阴性葡萄球菌引起早发性（31%）和多数中间型（40%）疾病，与其他病原体相比，其植入至感染的中位时间更短（6.5 比 61.3 个月；P<.001）。草绿色链球菌和肠球菌主要引起迟发性心内膜炎。对于球菌引起的活动性感染，大多数病例革兰染色强阳性，但 4 例仅强阳性格罗特氏银染色。
球菌占感染的 83%。早发性人造瓣膜心内膜炎主要由葡萄球菌引起，迟发性人造瓣膜心内膜炎类似于原生瓣膜心内膜炎。革兰染色和格罗特氏银染色均有必要用于可靠地识别微生物。
