Defraigne J O, Dalem A M, Demoulin J C, Limet R
Department of Cardiovascular Surgery, University Hospital, Sart-Tilman, Liège.
Acta Chir Belg. 1989 Sep-Oct;89(5):247-52.
Between 1981 and 1987, 29 patients (20 men and 9 women, mean age 46 +/- 15) underwent a valvular replacement for endocarditis (19 aortic and 10 mitral). There were 25 native and 4 prosthetic valves. In 85% of cases, underlying valvular lesions were present. The oropharyngeal and the respiratory tracts were the most common sources of infection. In 81%, the infecting microorganism was gram-positive. In 21% of cases, a gram-negative was detected, always mixed with a gram-positive. One infection was caused by a Candida. Indications for surgery were severe valvular insufficiency or cardiac failure (90%), refractory sepsis (21%), thromboembolic events (11%). In 22%, multiple factors were present. A biologic valve was chosen in 12 cases (40%). Simultaneously with the valvular replacement, 4 ventricular septal perforations were occluded and 3 valvular annulus abscesses debrided. The operative mortality was 10% (3/29). The one-year survival is 96%. Two patients required reoperation at 6 months and 2 years, for partial dehiscence, with good subsequent evolution. The authors concluded that surgical operation is the most suitable treatment for unstable or complicated endocarditis, in case of cardiac failure, iterative thromboembolic events or refractory sepsis.
1981年至1987年间，29例患者（20例男性，9例女性，平均年龄46±15岁）因感染性心内膜炎接受了瓣膜置换术（19例主动脉瓣置换，10例二尖瓣置换）。其中有25个自体瓣膜和4个人工瓣膜。85%的病例存在潜在的瓣膜病变。口咽部和呼吸道是最常见的感染源。81%的病例中，感染微生物为革兰氏阳性菌。21%的病例检测到革兰氏阴性菌，且总是与革兰氏阳性菌混合存在。1例感染由念珠菌引起。手术指征为严重瓣膜关闭不全或心力衰竭（90%）、难治性败血症（21%）、血栓栓塞事件（11%）。22%的病例存在多种因素。12例（40%）选择了生物瓣膜。在进行瓣膜置换的同时，封堵了4个室间隔穿孔，并清除了3个瓣膜环脓肿。手术死亡率为10%（3/29）。1年生存率为96%。2例患者分别在6个月和2年时因部分裂开需要再次手术，随后病情顺利好转。作者得出结论，对于不稳定或复杂的感染性心内膜炎，在出现心力衰竭、反复血栓栓塞事件或难治性败血症的情况下，手术是最合适的治疗方法。
