Machelart I, Greib C, Wirth G, Camou F, Issa N, Viallard J F, Pellegrin J L, Lazaro E
Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France.
Department of Infectious Diseases, Pellegrin Hospital, Bordeaux, France.
Diagn Microbiol Infect Dis. 2017 Jun;88(2):158-162. doi: 10.1016/j.diagmicrobio.2017.03.002. Epub 2017 Mar 7.
The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat.
A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature.
We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable.
Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.
Bentall手术是一种心脏外科手术，包括主动脉瓣、主动脉根部和升主动脉的移植物置换。Bentall手术后的移植物感染（BGI）虽不常见但很严重，且往往难以诊断和治疗。
使用波尔多大学医学中心2008年至2014年间收治的成人BGI患者的波尔多心内膜炎数据库进行了一项回顾性队列研究。在文献中确定了已发表的病例报告。
我们在数据库中识别出10例BGI患者，在文献中识别出13例。大多数感染为迟发性（20/23），由革兰氏阳性球菌细菌感染引起（16/22）。使用超声心动图、计算机断层扫描（CT）和正电子发射断层扫描/CT（PET/CT）对所述BGI进行了详细诊断。在任何病例中均未报告标记白细胞闪烁扫描。发现延长抗生素治疗和手术是BGI的首选治疗方法；然而，并非总是能够进行手术干预。即使PET/CT结果为阴性，仍会发生临床复发，而在没有临床复发的情况下，PET/CT对BGI始终呈阳性。这表明使用PET/CT进行随访存在疑问。
由于经食管超声心动图和CT获得的临床、生物学和放射学观察结果相互交织，BGI的诊断很困难。PET/CT是诊断BGI的一种替代方法，但其对临床管理的影响仍不清楚。目前的数据表明，如果无法进行假体的手术置换，应给予患者延长抗生素治疗。
