Fukuda Wakako, Daitoku Kazuyuki, Minakawa Masahito, Fukui Kozo, Suzuki Yasuyuki, Fukuda Ikuo
Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine.
Ann Thorac Cardiovasc Surg. 2014;20(3):229-36. doi: 10.5761/atcs.oa.13.02265. Epub 2013 Apr 5.
Management of patients with infective endocarditis complicated by neurological deficits is challenging. No clear management guidelines have been defined, and the timing of surgery remains controversial. The purpose of this study was to evaluate our management algorithm.
Thirty-eight adult patients with left-sided infective endocarditis undergoing valve surgery were analyzed. Before the operation, enhanced brain computed tomography (CT) was performed to rule out a cerebral complication. Pre and postoperative data were retrospectively reviewed to clarify whether our algorithm was effective. Sixteen patients having neurological complication (CVC group) were compared with 22 patients without neurological complication.
Age, sex, New York Heart Association (NYHA) functional class, affected valve and pathogens were not different between two groups. Mean interval from the onset of neurological dysfunction to cardiac operation was 27.8 ± 27.8 days (median 23 days). Of the 16 CVC group patients, 12 experienced cerebral infarction. Mass effects were seen in 3 patients, with 1 of these 3 patients died following aneurysm rupture. Mycotic aneurysm was detected in 4 patients, with 3 undergoing successful staged operations. Mortality and postoperative neurological exacerbation in CVC group was 6.3% (1 patient). Most patients who fulfilled the algorithm showed good outcomes.
Our suggested management algorithm for infective endocarditis appears effective.
感染性心内膜炎合并神经功能缺损患者的管理具有挑战性。目前尚无明确的管理指南，手术时机仍存在争议。本研究的目的是评估我们的管理算法。
分析38例接受瓣膜手术的左侧感染性心内膜炎成年患者。术前进行增强脑计算机断层扫描（CT）以排除脑部并发症。回顾性分析术前和术后数据，以明确我们的算法是否有效。将16例有神经并发症的患者（CVC组）与22例无神经并发症的患者进行比较。
两组在年龄、性别、纽约心脏协会（NYHA）功能分级、受累瓣膜和病原体方面无差异。从神经功能障碍发作到心脏手术的平均间隔时间为27.8±27.8天（中位数23天）。在16例CVC组患者中，12例发生脑梗死。3例出现占位效应，其中1例患者在动脉瘤破裂后死亡。4例检测到真菌性动脉瘤，3例成功进行了分期手术。CVC组的死亡率和术后神经功能恶化率为6.3%（1例患者）。大多数符合该算法的患者预后良好。
我们建议的感染性心内膜炎管理算法似乎有效。
