Fukuda Wakako, Daitoku Kazuyuki, Minakawa Masahito, Fukui Kozo, Suzuki Yasuyuki, Fukuda Ikuo
Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Interact Cardiovasc Thorac Surg. 2012 Jan;14(1):26-30. doi: 10.1093/icvts/ivr038. Epub 2011 Nov 15.
Management of infective endocarditis (IE) with cerebrovascular complications is difficult due to absence of concrete evidence. These patients usually have multiple neurological deficits and the optimal timing for cardiac operation remains controversial. The aims of this study were to present cases and discuss the treatment options for IE with cerebrovascular complications. From 1998 to 2010, 51 patients underwent operations for IE at our institution. From a review of medical records, 10 patients (19.6%) with preoperative neurological complications were identified. Data on these 10 patients were analysed. Cerebrovascular complications included cerebral infarction (n = 4, 40.0%), mycotic aneurysm (n = 1, 10.0%), mycotic aneurysm plus cerebral infarction (n = 3, 30.0%), meningitis (n = 1, 10.0%) and mycotic aneurysm with cerebral haemorrhage plus meningitis (n = 1, 10.0%). Of 5 patients having mycotic aneurysms, 3 underwent clipping before cardiac operations. The mean interval from craniotomy to cardiac operations was 26.7 ± 21.8 days. A cardiac operation was performed initially on seven patients. The mean interval from the onset of neurological deficit to cardiac operation was 7.4 ± 9.8 days. The mortality rate was 10.0%. Postoperative deterioration was not observed. Management of IE with cerebrovascular complications should be based on case-by-case multidisciplinary assessment of potential risks and benefits of intracranial and cardiac operations.
由于缺乏确凿证据，感染性心内膜炎（IE）合并脑血管并发症的管理颇具难度。这些患者通常存在多种神经功能缺损，心脏手术的最佳时机仍存在争议。本研究的目的是呈现病例并讨论IE合并脑血管并发症的治疗选择。1998年至2010年，我院有51例患者接受了IE手术。通过查阅病历，确定了10例（19.6%）术前存在神经并发症的患者。对这10例患者的数据进行了分析。脑血管并发症包括脑梗死（n = 4，40.0%）、真菌性动脉瘤（n = 1，10.0%）、真菌性动脉瘤合并脑梗死（n = 3，30.0%）、脑膜炎（n = 1，10.0%）以及真菌性动脉瘤合并脑出血及脑膜炎（n = 1，10.0%）。在5例患有真菌性动脉瘤的患者中，3例在心脏手术前行夹闭术。开颅手术至心脏手术的平均间隔时间为26.7±21.8天。7例患者首先进行了心脏手术。神经功能缺损发作至心脏手术的平均间隔时间为7.4±9.8天。死亡率为10.0%。未观察到术后病情恶化。IE合并脑血管并发症的管理应基于对颅内和心脏手术潜在风险和益处的逐案多学科评估。
