Omoto Tadashi, Tedoriya Takeo, Oi Masaya, Nagai Naoko, Miyauchi Tadamasa, Ishikawa Noboru
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Showa University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo, Japan.
Asian Cardiovasc Thorac Ann. 2011 Apr;19(2):149-53. doi: 10.1177/0218492311401391.
Mitral valve repair is preferred to replacement in infective endocarditis, but in the active phase, it often requires extensive debridement of infected tissue and complex reconstruction. We investigated 22 consecutive native mitral valve operations during active-phase infective endocarditis. The time from initiation of medical treatment to operation was 16.8 ± 16.4 days. Mitral valve repair was performed in 15 (68.2%) patients, using prosthetic annuloplasty in 14, an autologous pericardial patch in 11, and artificial chordal replacement in 9. Hospital mortality was 9.1% (2 patients), due to subarachnoid hemorrhage and pneumonia. One patient died 26 months after valve replacement due to congestive heart failure. The postoperative left ventricular end-diastolic dimension was significantly smaller (45.7 ± 5.6 vs. 53.3 ± 10.2 mm) and ejection fraction was significantly higher (57.0% ± 14.7% vs. 40.1% ± 8.2%) in patients who underwent valve repair compared to those who had valve replacement. Mitral regurgitation requiring reoperation occurred in 3 patients during follow-up. Mitral valve repair is feasible in active-phase infective endocarditis, and results in improved regression of left ventricular dimensions compared to valve replacement. However, complex mitral valve repair with extensive leaflet resection may not have long-term durability.
在感染性心内膜炎中，二尖瓣修复术优于置换术，但在急性期，通常需要广泛清除感染组织并进行复杂的重建。我们调查了22例连续的急性期感染性心内膜炎患者的二尖瓣手术。从开始药物治疗到手术的时间为16.8±16.4天。15例（68.2%）患者接受了二尖瓣修复术，其中14例使用了人工瓣环成形术，11例使用了自体心包补片，9例使用了人工腱索置换。医院死亡率为9.1%（2例患者），原因是蛛网膜下腔出血和肺炎。1例患者在瓣膜置换术后26个月因充血性心力衰竭死亡。与接受瓣膜置换的患者相比，接受瓣膜修复的患者术后左心室舒张末期内径显著更小（45.7±5.6对53.3±10.2mm），射血分数显著更高（57.0%±14.7%对40.1%±8.2%）。随访期间有3例患者发生二尖瓣反流需要再次手术。二尖瓣修复术在急性期感染性心内膜炎中是可行的，与瓣膜置换相比，可使左心室尺寸更好地恢复。然而，广泛切除瓣叶的复杂二尖瓣修复术可能没有长期耐久性。
