Robichaud Brian, Hill Garick, Cohen Scott, Woods Ronald, Earing Michael, Frommelt Peter, Ginde Salil
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Congenit Heart Dis. 2018 Sep;13(5):734-739. doi: 10.1111/chd.12639. Epub 2018 Sep 17.
Pulmonary valve replacement (PVR) is a common operation in patients with congenital heart disease (CHD). As survival with CHD improves, infective endocarditis (IE) is a growing complication after PVR. The aim of this study was to assess the incidence, risk factors, and clinical outcomes of IE after surgical PVR in patients with CHD at our institution.
Retrospective analysis of all cases of surgical PVR performed at Children's Hospital of Wisconsin between 1975 and 2016 was performed. All cases of IE after PVR were identified and clinical and imaging data were obtained by review of medical records.
Out of 924 surgical PVRs, there were 19 (2%) cases of IE. The incidence of IE after surgical PVR was 333 cases per 100,000 person-years. The median age at diagnosis of IE was 21 years (range = 1.2-34 years) and the median time from PVR to diagnosis of IE was 9.4 years. The overall freedom from IE after PVR was 99.1%, 96.9%, and 93.4%, at 5, 10, and 15 years, respectively. There was no significant difference in freedom from IE based on valve type, including bovine jugular vein grafts. Patients with IE were more likely to have had a history of multiple PVRs, while length of follow-up after PVR, age at time of PVR, and gender were not significant risk factors. Eleven (58%) cases of IE required surgical intervention, while 8 (42%) were successfully treated with intravenous antibiotics alone. There were no deaths and no recurrences of IE after treatment.
The overall risk for IE after PVR is low. There was no association between age or type of pulmonary valve and risk of IE. The majority of cases require surgical intervention, but in general the outcomes of IE after PVR are good with low mortality and risk of recurrence.
肺动脉瓣置换术（PVR）是先天性心脏病（CHD）患者的常见手术。随着CHD患者生存率的提高，感染性心内膜炎（IE）成为PVR术后日益常见的并发症。本研究旨在评估我院CHD患者手术PVR术后IE的发生率、危险因素及临床结局。
对1975年至2016年在威斯康星儿童医院进行的所有手术PVR病例进行回顾性分析。识别出所有PVR术后IE病例，并通过查阅病历获取临床和影像学数据。
在924例手术PVR中，有19例（2%）发生IE。手术PVR术后IE的发生率为每100,000人年333例。IE诊断时的中位年龄为21岁（范围=1.2 - 34岁），从PVR到IE诊断的中位时间为9.4年。PVR术后5年、10年和15年的IE总体无病生存率分别为99.1%、96.9%和93.4%。基于瓣膜类型（包括牛颈静脉移植物）的IE无病生存率无显著差异。IE患者更可能有多次PVR病史，而PVR术后随访时间、PVR时年龄和性别不是显著危险因素。11例（58%）IE病例需要手术干预，而8例（42%）仅通过静脉抗生素治疗成功治愈。治疗后无死亡病例，也无IE复发。
PVR术后IE的总体风险较低。肺动脉瓣的年龄或类型与IE风险之间无关联。大多数病例需要手术干预，但总体而言，PVR术后IE的结局良好，死亡率和复发风险较低。
