Dressler F A, Roberts W C
Pathology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892.
Am J Cardiol. 1989 May 15;63(17):1240-57. doi: 10.1016/0002-9149(89)90186-0.
Eighty opiate addicts were studied at necropsy. Fifty-nine patients had anatomic evidence of active infective endocarditis (IE); 11 had healed IE; and 10 had both. Of the 80 patients, the first episode of IE involved a single right-sided cardiac valve in 24 patients (30%); both a right- and a left-sided valve in 13 patients (16%); a single left-sided valve in 33 patients (41%); and both left-sided valves in 10 patients (13%). Of the 320 cardiac valves in the 80 patients, 103 were sites of vegetations, an average of 1.3 of the 4 valves. Of the 80 patients, the tricuspid valve was infected in 35 (44%), mitral in 34 (43%), aortic in 32 (40%) and pulmonic in 2 (3%). Of the 103 infected cardiac valves, the infection caused sufficient damage to cause dysfunction in 70 (68%): in 28 (88%) of 32 infected aortic valves; in 22 (63%) of 35 infected tricuspid valves; in 19 (56%) of the 34 infected mitral valves; and in 1 of the 2 infected pulmonic valves. Of the 80 patients, 57 (71%) had sufficient valvular damage to cause valvular dysfunction. Of the 80 patients, gross examination of the valves at necropsy indicated that the infected valve almost certainly had been anatomically normal in 65 patients (81%) and abnormal in 15 patients (19%) before the onset of IE. Of the 65 patients with previously anatomically normal valves, 86 (33%) of their 260 cardiac valves were sites of infection (average 1.3 valves/patient); of the 15 patients with infection superimposed on a previously abnormal valve, the infection in each involved previously abnormal valves (21 in the 15 patients) or 17 (28%) of their 60 cardiac valves were sites of infection (average 1.1 valve/patient). Of the 15 patients with abnormal cardiac valves before the infection, 7 had congenitally bicuspid aortic valves and 8 had diffuse fibrous thickening of the mitral valve typical of rheumatic heart disease with (6 patients) or without (2 patients) diffuse fibrous thickening of tricuspid aortic valves. Of the 80 patients, 42 (53%) died during their first episode of active IE, 17 (21%) underwent operative excision with or without valve replacement during the active IE, and in 21 patients (26%) the first episode of active IE healed. In 10 of the latter 21 patients, active IE recurred and was fatal. A total of 19 patients had cardiac valve excision with or without replacement, 17 during active IE and 2 after healing.(ABSTRACT TRUNCATED AT 250 WORDS)
对80名阿片类药物成瘾者进行了尸检研究。59例患者有活动性感染性心内膜炎（IE）的解剖学证据；11例有愈合的IE；10例两者皆有。在这80例患者中，IE的首发累及单个右侧心脏瓣膜的有24例（30%）；右侧和左侧瓣膜均受累的有13例（16%）；单个左侧瓣膜受累的有33例（41%）；双侧左侧瓣膜受累的有10例（13%）。在这80例患者的320个心脏瓣膜中，103个是赘生物附着部位，平均每个患者4个瓣膜中有1.3个受累。在这80例患者中，三尖瓣感染的有35例（44%），二尖瓣感染的有34例（43%），主动脉瓣感染的有32例（40%），肺动脉瓣感染的有2例（3%）。在103个受感染的心脏瓣膜中，感染造成足够损害导致功能障碍的有70个（68%）：32个受感染主动脉瓣中的28个（88%）；35个受感染三尖瓣中的22个（63%）；34个受感染二尖瓣中的19个（56%）；2个受感染肺动脉瓣中的1个。在这80例患者中，57例（71%）有足够的瓣膜损害导致瓣膜功能障碍。在这80例患者中，尸检时对瓣膜的大体检查表明，65例患者（81%）受感染的瓣膜在IE发作前几乎肯定解剖结构正常，15例患者（19%）的瓣膜在IE发作前异常。在65例先前解剖结构正常的瓣膜患者中，其260个心脏瓣膜中有86个（33%）是感染部位（平均每个患者1.3个瓣膜）；在15例感染叠加在先前异常瓣膜上的患者中，每个患者的感染累及先前异常的瓣膜（15例患者共21个），或其60个心脏瓣膜中有17个（28%）是感染部位（平均每个患者1.1个瓣膜））。在感染前心脏瓣膜异常的15例患者中，7例有先天性二叶式主动脉瓣，8例有典型风湿性心脏病的二尖瓣弥漫性纤维增厚，其中6例三尖瓣有弥漫性纤维增厚，2例没有。在这80例患者中，42例（53%）在活动性IE的首次发作期间死亡，17例（21%）在活动性IE期间接受了手术切除，伴或不伴瓣膜置换，21例患者（26%）的活动性IE首次发作愈合。在后者这21例患者中，10例活动性IE复发并致命。共有19例患者接受了心脏瓣膜切除，伴或不伴置换，17例在活动性IE期间，2例在愈合后。（摘要截短至250字）
