Ergin M A, Raissi S, Follis F, Lansman S L, Griepp R B
Division of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, N.Y. 10029.
J Thorac Cardiovasc Surg. 1989 May;97(5):755-63.
Destruction and disruption of ventricular-aortic or mitral-aortic continuity in the presence of acute infection of the annular tissue is a significant surgical challenge. Among 82 patients who underwent surgical treatment for acute endocarditis over a 10-year period, 15 (18.2%) had extensive destruction of the anulus necessitating special reconstructive techniques for treatment. Surgical treatment involved removal of all infected tissue including annular elements followed by appropriate restoration of the anulus for safe anchoring of the prosthetic valve. The reconstruction of the anulus consisted of the following: a Teflon felt patch inside and outside the aorta or ventricle, or both, for secure attachment of the prosthesis (felt aortic root, in three patients with native valve endocarditis), valved composite graft replacement of the aortic root for ventricular-aortic discontinuity (Bentall procedure, in eight patients with prosthetic valve endocarditis), composite patch reconstruction of the mitral anulus and the ascending aorta to restore mitral-aortic continuity (mitral-aortic composite patch in two patients with mitral-aortic prosthetic valve endocarditis), and direct suture of the sewing skirts of the mitral and aortic prostheses to restore the defect (attached skirts, in one patient with mitral-aortic native valve endocarditis). There was one hospital death caused by multiple organ failure. The most common complication was heart block. Two late deaths were due to reinfection resulting from continued intravenous drug abuse. One patient with a felt aortic root repair required late reoperation for subannular aneurysm. Eleven patients were followed up from 7 months to 66 months and are alive and well without complications. This experience indicates that these seemingly radical surgical techniques can be used in these desperately ill patients with safety and good long-term results. They offer the only lasting solution for major disruption in cardiac anatomy in the presence of infection.
在瓣环组织急性感染的情况下，破坏和中断心室 - 主动脉或二尖瓣 - 主动脉连续性是一项重大的外科挑战。在10年期间接受急性心内膜炎手术治疗的82例患者中，15例（18.2%）瓣环广泛破坏，需要采用特殊的重建技术进行治疗。手术治疗包括切除所有感染组织，包括瓣环成分，然后对瓣环进行适当修复，以便安全地固定人工瓣膜。瓣环重建包括以下方法：在主动脉或心室内部及外部，或两者都使用特氟龙毡片，以牢固固定假体（毡片主动脉根部，用于3例天然瓣膜心内膜炎患者）；对于心室 - 主动脉连续性中断，采用带瓣复合移植物置换主动脉根部（Bentall手术，用于8例人工瓣膜心内膜炎患者）；对二尖瓣瓣环和升主动脉进行复合补片重建，以恢复二尖瓣 - 主动脉连续性（二尖瓣 - 主动脉复合补片，用于2例二尖瓣 - 主动脉人工瓣膜心内膜炎患者）；直接缝合二尖瓣和主动脉假体的缝合裙边以修复缺损（附着裙边，用于1例二尖瓣 - 主动脉天然瓣膜心内膜炎患者）。有1例患者因多器官衰竭在医院死亡。最常见的并发症是心脏传导阻滞。2例晚期死亡是由于持续静脉药物滥用导致的再次感染。1例采用毡片主动脉根部修复的患者因瓣环下动脉瘤需要后期再次手术。11例患者随访7个月至66个月，均存活且无并发症。这一经验表明，这些看似激进的外科技术可安全地用于这些重症患者，并能取得良好的长期效果。它们为感染情况下心脏解剖结构的重大破坏提供了唯一持久的解决方案。
