Benzarouel D, Ouanan F, Boumzebra D, El Hattaoui M
Service de cardiologie, hôpital Ibn Tofail, CHU Mohamed VI, Marrakech, Maroc.
Ann Cardiol Angeiol (Paris). 2012 Aug;61(4):274-80. doi: 10.1016/j.ancard.2011.09.007. Epub 2011 Oct 20.
To determine clinical, echocardiographic features, management and outcomes of patients presenting peri aortic abscess complicating infective endocarditis (IE) and demonstrate the impact of periaortic abscess on morbidity and mortality of these patients.
We have analyzed clinical, microbiological, echocardiographic aspects, therapies and outcomes of patients with aortic abscess occurring during IE, and we compared these data with those of patients presenting IE without peri aortic abscess in the same period in the cardiology department of the University Hospital of Marrakech from January 2006 to January 2010.
Above 56 cases of infective endocarditis, 16 patients had an aortic abscess. Mean age was 33 ± 11 years with a clear male predominance in the group IE with abscess versus IE without abscess. Heart failure was noted in all patients in periaortic abscess group, and was more severe in this group compared to control. Streptococcus and staphylococcus predominated with no significant difference between the two groups. Transthoracic echocardiography coupled with transesophageal echocardiography made the diagnosis of aortic abscess witch was isolated in 11 cases and associated with other complications in five cases. In terms of complications, splenic infarction was more frequent in the group with abscess (25 versus 2.5%, P<0.05). There was not a significant difference between the two groups for the others complications. Surgery associated with a double antibiotic therapy was the standard treatment with a variable delay for surgery of four days to four weeks. Hospital mortality in the acute phase was higher in periaortic abscess group (37% versus 10%, P<0.05). The evolution of survivors at six months was favorable.
Periaortic abscess complicating IE is associated with a high morbidity and mortality in spite of modern approach as well as on medical or surgical treatment. It requires therefore a strict monitoring of patients with infective endocarditis.
确定合并感染性心内膜炎（IE）的主动脉周围脓肿患者的临床、超声心动图特征、治疗方法及预后，并阐明主动脉周围脓肿对这些患者发病率和死亡率的影响。
我们分析了IE期间发生主动脉脓肿患者的临床、微生物学、超声心动图方面、治疗方法及预后，并将这些数据与2006年1月至2010年1月在马拉喀什大学医院心内科同期出现的无主动脉周围脓肿的IE患者的数据进行比较。
在56例以上的感染性心内膜炎患者中，16例有主动脉脓肿。平均年龄为33±11岁，主动脉脓肿组的IE患者中男性明显占主导，与无脓肿的IE组相比。主动脉周围脓肿组所有患者均出现心力衰竭，且该组心力衰竭比对照组更严重。链球菌和葡萄球菌占主导，两组之间无显著差异。经胸超声心动图联合经食管超声心动图诊断出主动脉脓肿，其中11例为孤立性，5例伴有其他并发症。在并发症方面，脓肿组脾梗死更常见（25%对2.5%，P<0.05）。两组在其他并发症方面无显著差异。手术联合双重抗生素治疗是标准治疗方法，手术延迟时间从4天到4周不等。主动脉周围脓肿组急性期医院死亡率更高（37%对10%，P<0.05）。幸存者6个月时的病情进展良好。
尽管采用了现代方法以及药物或手术治疗，合并IE的主动脉周围脓肿仍与高发病率和死亡率相关。因此，需要对感染性心内膜炎患者进行严格监测。
