Outpatient Cardiology Service, Fabriano Hospital, Asur Marche, Italy.
J Cardiovasc Med (Hagerstown). 2010 Dec;11(12):869-83. doi: 10.2459/JCM.0b013e328336ec9a.
Prosthetic valve endocarditis (PVE) is associated with a high mortality during the early and midterm follow-up despite diagnostic and therapeutic improvements; its incidence is increasing and reaches 20-30% of all infective endocarditis episodes. In this review, changes in epidemiology, microbiology, diagnosis and therapy that have evolved in the past few years are analyzed. Staphylococci (both Staphylococcus aureus and coagulase-negative Staphylococcus) have emerged as the most common cause of PVE and are associated with a severe prognosis. Moreover, diagnosis may often be difficult because of its complications and extracardiac manifestations; thus, a comprehensive assessment of the clinical, echocardiographic and laboratory data must be performed. Early PVE, comorbidity, severe heart failure and new prosthetic dehiscence are predictors of mortality. Therapy is not indicated by evidence-based recommendations but mostly on identification of the high-risk conditions. A PVE is a common indication for surgery, whereas medical treatment alone may be achieved in a few instances. Systematic prophylaxis should be used to prevent this severe complication of cardiac valve replacement.
人工瓣膜心内膜炎（PVE）尽管在诊断和治疗上有所改进，但在早期和中期随访期间仍与高死亡率相关；其发病率正在增加，达到所有感染性心内膜炎发作的 20-30%。在这篇综述中，分析了过去几年中在流行病学、微生物学、诊断和治疗方面发生的变化。葡萄球菌（金黄色葡萄球菌和凝固酶阴性葡萄球菌）已成为 PVE 的最常见原因，且与严重的预后相关。此外，由于其并发症和心脏外表现，诊断往往较为困难；因此，必须对临床、超声心动图和实验室数据进行全面评估。早期 PVE、合并症、严重心力衰竭和新的人工瓣膜裂开是死亡的预测因素。治疗不是基于循证建议，而是主要基于高危情况的识别。PVE 是心脏瓣膜置换术的常见适应证，而在某些情况下仅通过药物治疗即可实现。应使用系统预防来预防这种心脏瓣膜置换术的严重并发症。
