Ramos Tuarez Fergie J., Yelamanchili Varun S., Sharma Sanjeev, Law Mark A.
University of Miami
Mclaren Hospital System
A cardiac abscess is a suppurative infection of the myocardium, endocardium, and native or prosthetic valve tissue. Like other abscesses, it develops either by dissemination from a distant source such as bacteremia or sepsis or by direct extension of a preexisting cardiac infective focus. Infective endocarditis has long been identified as the main cause of the latter. Although the incidence of cardiac abscesses continues to be investigated, it is presumably higher than noted postmortem and is of great importance when deciding the prognosis of and therapeutic strategy for patients. Cardiac abscesses are typically monomicrobial; the most common etiologic agents are or . Polymicrobial cardiac abscesses are less typical but do occur Myocardial abscesses may also form in regions of the heart that have experienced prior damage, such as those affected by recent infarction. Significant complications of a cardiac abscess, whether alone or with valve tissue, are conduction abnormalities. The incidence of perivalvular abscess among patients with infective endocarditis is between 30% and 40%, with the aortic valve having a higher predisposition than the mitral valve and annulus. Native aortic valve endocarditis, usually located in a weak part of the annulus near the atrioventricular node (AV), clearly demonstrates the anatomic predisposition and exemplifies why abscesses and heart block present as frequent sequelae. Perivalvular abscesses are also more familiar with prosthetic valves. In this case, the annulus, instead of the leaflet, is usually the primary site of infection. The degree of conduction disruption, therefore, depends on the extent of the involvement of the conduction system and is more commonly seen in perivalvular aortic abscesses. Additionally, the severe extension of perivalvular infection can also result in extrinsic coronary arterial compression or disruption, leading to acute coronary syndrome. Thus far, only aortic valve involvement and current intravenous drug use (IVDU) have been prospectively identified as independent risk factors for a perivalvular abscess. Any patient with a cardiac abscess, regardless of all other factors, has an increased risk of embolization, morbidity, and mortality. Right-sided infective endocarditis represents 5% to 10% of all cases and is frequently linked to IVDU, intracardiac devices, and central venous catheters. The prevalence of these factors has increased in the United States over the last 2 decades.
心脏脓肿是心肌、心内膜以及天然或人工瓣膜组织的化脓性感染。与其他脓肿一样，它的形成要么是由远处来源（如菌血症或败血症）播散而来，要么是由先前存在的心脏感染灶直接蔓延所致。长期以来，感染性心内膜炎一直被认为是后者的主要原因。尽管心脏脓肿的发病率仍在研究中，但据推测其实际发病率高于尸检记录，并且在决定患者的预后和治疗策略方面具有重要意义。心脏脓肿通常为单一微生物感染；最常见的病原体是……或……。多微生物性心脏脓肿不太常见，但确实会发生。心肌脓肿也可能在心脏先前受过损伤的区域形成，例如近期梗死所累及的区域。心脏脓肿的重要并发症，无论是否累及瓣膜组织，都是传导异常。感染性心内膜炎患者中瓣周脓肿的发生率在30%至40%之间，主动脉瓣比二尖瓣及瓣环更易发生。天然主动脉瓣心内膜炎通常位于瓣环靠近房室结（AV）的薄弱部位，清楚地显示了解剖学上的易患因素，并例证了为什么脓肿和心脏传导阻滞是常见的后遗症。瓣周脓肿在人工瓣膜中也更为常见。在这种情况下，瓣环而非瓣叶通常是主要感染部位。因此，传导系统受干扰的程度取决于传导系统受累的范围，在瓣周主动脉脓肿中更为常见。此外，瓣周感染的严重蔓延还可导致冠状动脉外部受压或中断，引发急性冠状动脉综合征。到目前为止，只有主动脉瓣受累和当前静脉药物使用（IVDU）被前瞻性地确定为瓣周脓肿的独立危险因素。任何患有心脏脓肿的患者，无论其他因素如何，发生栓塞、发病和死亡风险都会增加。右侧感染性心内膜炎占所有病例的5%至10%，常与IVDU、心内装置和中心静脉导管有关。在过去20年里，美国这些因素的患病率有所增加。
