David T E, Komeda M, Brofman P R
Division of Cardiovascular Surgery, Toronto Western Hospital, Ontario, Canada.
Circulation. 1989 Sep;80(3 Pt 1):I269-74.
A significant number of patients with infective aortic valve endocarditis develop aortic annular abscess. Although antibiotics may occasionally sterilize an aortic root abscess, most patients require surgical intervention. A review of our experience with 21 consecutive patients surgically treated for aortic root abscess disclosed that 13 patients had prosthetic valve and eight had native aortic valve endocarditis. The predominant microorganism was Staphylococcus aureus, particularly in those patients with native aortic valve endocarditis. The abscess was limited to the aortic annulus in 10 patients and was either multiple or had perforated the left ventricular outflow tract in 11 patients. Most patients were desperately ill at the time of operation. Repair was accomplished by aggressive debridement of all apparently infected tissue and reconstruction of the left ventricular outflow tract with autologous pericardium. Although postoperative complications were common, only one patient died in hospital. Operative survivors have been followed up from 3 to 68 months (mean, 29 months). One patient died of complications of repair of a thoracoabdominal aneurysm 34 months after surgery; his prosthetic aortic valve and patch were intact at autopsy. No patient has experienced recurrent infection, pericardial patch aneurysm, or prosthetic valve dehiscence.
相当一部分感染性主动脉瓣心内膜炎患者会发生主动脉瓣环脓肿。尽管抗生素偶尔可能使主动脉根部脓肿无菌化，但大多数患者需要手术干预。回顾我们对21例接受主动脉根部脓肿手术治疗的连续患者的经验发现，13例患者有人工瓣膜，8例有天然主动脉瓣心内膜炎。主要微生物是金黄色葡萄球菌，尤其是在那些患有天然主动脉瓣心内膜炎的患者中。10例患者的脓肿局限于主动脉瓣环，11例患者的脓肿为多发或已穿破左心室流出道。大多数患者在手术时病情危急。通过积极清除所有明显感染的组织并用自体心包重建左心室流出道来完成修复。尽管术后并发症很常见，但只有1例患者在医院死亡。手术幸存者的随访时间为3至68个月（平均29个月）。1例患者在术后34个月死于胸腹主动脉瘤修复并发症；尸检时其人工主动脉瓣和补片完好无损。没有患者经历过反复感染、心包补片动脉瘤或人工瓣膜裂开。
