Berglund Elisabeth, Johansson Bengt, Dellborg Mikael, Sörensson Peder, Christersson Christina, Nielsen Niels-Eric, Rinnström Daniel, Thilén Ulf
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Heart. 2016 Nov 15;102(22):1835-1839. doi: 10.1136/heartjnl-2015-309133. Epub 2016 Jul 21.
Ventricular septal defects (VSDs), if haemodynamically important, are closed whereas small shunts are left without intervention. The long-term prognosis in congenital VSD is good but patients are still at risk for long-term complications. The aim of this study was to clarify the incidence of infective endocarditis (IE) in adults with VSD.
The Swedish registry for congenital heart disease (SWEDCON) was searched for adults with VSD. 779 patients were identified, 531 with small shunts and 248 who had the VSD previously closed. The National Patient Register was then searched for hospitalisations due to IE in adults during a 10-year period.
Sixteen (2%) patients were treated for IE, 6 men and 10 women, with a mean age of 46.3±12.2 years. The incidence of IE was 1.7-2.7/1000 years in patients without previous intervention, 20-30 times the risk in the general population. Thirteen had small shunts without previous intervention. There was no mortality in these 13 cases. Two patients had undergone repair of their VSD and also aortic valve replacement before the episode of endocarditis and a third patient with repaired VSD had a bicuspid aortic valve, all of these three patients needed reoperation because of their IE and one patient died. No patient with isolated and operated VSD was diagnosed with IE.
A small unoperated VSD in adults carries a substantially increased risk of IE but is associated with a low risk of mortality.
对于血流动力学有重要意义的室间隔缺损（VSD）进行封堵，而小分流则不予干预。先天性VSD的长期预后良好，但患者仍有发生长期并发症的风险。本研究的目的是明确成人VSD患者感染性心内膜炎（IE）的发生率。
在瑞典先天性心脏病登记处（SWEDCON）中查找患有VSD的成人患者。共识别出779例患者，其中531例为小分流患者，248例之前已对VSD进行了封堵。然后在国家患者登记处中查找10年间成人因IE住院的情况。
16例（2%）患者接受了IE治疗，男性6例，女性10例，平均年龄46.3±12.2岁。未接受过干预的患者IE发生率为1.7 - 2.7/1000人年，是普通人群风险的20 - 30倍。13例为未接受过干预的小分流患者。这13例患者均无死亡。2例患者在发生心内膜炎之前已对VSD进行了修复并置换了主动脉瓣，第3例已修复VSD的患者有二叶式主动脉瓣，这3例患者均因IE需要再次手术，1例患者死亡。没有孤立且已手术治疗的VSD患者被诊断为IE。
成人未手术治疗的小VSD发生IE的风险大幅增加，但死亡率较低。
