25例人工瓣膜心内膜炎的临床分析

Wang Huan-ling, Fan Hong-wei, Fang Li-gang, Zhu Wei-guo, Zhang Heng, Liu Zheng-yin, Li Tai-sheng, Deng Guo-hua, Sheng Rui-yuan, Wang Ai-xia

Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.

Zhonghua Nei Ke Za Zhi. 2010 Sep;49(9):758-61.

OBJECTIVE

To report the clinical characteristics of prosthetic valve endocarditis (PVE).

METHODS

All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥ 3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied.

RESULTS

(1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%), major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2 Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonas maltophilia, and 1 Streptococcus. (3) Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings. Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements.

CONCLUSIONS

PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.

目的

报告人工瓣膜心内膜炎（PVE）的临床特征。

方法

回顾性分析1992年1月至2008年12月在我院确诊的25例明确的PVE（杜克标准）病例。其中7例经病理证实，其余病例根据2项主要标准或1项主要标准及≥3项次要标准临床确诊。研究其临床特征、基础心脏病、既往心脏手术、临床表现、致病微生物、超声心动图表现及预后。

结果

（1）虽然大多数病例因风湿性心脏病和先天性心脏病等基础心脏病接受瓣膜置换术，但10例患者在手术前合并感染性心内膜炎（IE），其中4例为PVE。（2）11例在术后2个月内发生PVE。发热（100%）、大血管栓塞（48%）和贫血（36%）是最常见的表现。14例（56%）血培养阳性，共检出15种致病病原体，包括5株凝固酶阴性葡萄球菌（CNS，3株为耐甲氧西林凝固酶阴性葡萄球菌，MRSCoN）、4株真菌、2株粪肠球菌、2株洋葱伯克霍尔德菌、1株嗜麦芽窄食单胞菌和1株链球菌。（3）人工瓣膜赘生物、瓣周漏、反流是主要的超声心动图表现。经食管超声心动图（TEE）显示13例PVE患者经胸超声心动图（TTE）检查无阳性发现。（4）18例PVE（72%）发生瓣周并发症（12例漏血、3例裂开、2例脓肿、1例瘘管），常观察到大血管栓塞、充血性心力衰竭（16%），17例患者中有9例尽管进行了积极治疗仍死于医院。