Selton-Suty Christine, Goehringer François, Venner Clément, Thivilier Carine, Huttin Olivier, Hoen Bruno
CHU Nancy-Brabois, département de cardiologie, 54511 Vandœuvre-lès-Nancy, France.
CHU Nancy-Brabois, département de maladies infectieuses, 54511 Vandœuvre-lès-Nancy, France.
Presse Med. 2019 May;48(5):532-538. doi: 10.1016/j.lpm.2019.04.002. Epub 2019 May 2.
Clinical manifestations of infective endocarditis may involve almost all body organs. They are usually classified as either cardiac or extra-cardiac complications. The first stage of infection is the development of intra-cardiac vegetation, which may further spread with an increase in size and number of vegetations, destructive valve lesions, and perivalvular extension of the infection. These anatomical lesions are responsible for hemodynamic disorders, mostly valvular regurgitation, and often lead to heart failure, which is the most frequent complication of IE. Embolic events may affect various vascular territories, the most frequent sites being brain, spleen and kidney for left-sided IE, and lung for right-sided IE. Cerebral complications may be of ischemic, hemorrhagic and/or infectious origin, are often the revealing symptoms of IE, and are well-recognized factors of poor prognosis. IE remains a dreadful disease with an in hospital mortality of 20%, a 5 year mortality of 40% and a significant morbidity.
感染性心内膜炎的临床表现几乎可累及身体所有器官。它们通常分为心脏并发症或心脏外并发症。感染的第一阶段是心内赘生物的形成，随着赘生物大小和数量的增加、瓣膜病变的破坏以及感染向瓣周扩展，赘生物可能会进一步扩散。这些解剖学病变会导致血流动力学紊乱，主要是瓣膜反流，并常常导致心力衰竭，这是感染性心内膜炎最常见的并发症。栓塞事件可能影响各个血管区域，左侧感染性心内膜炎最常见的部位是脑、脾和肾，右侧感染性心内膜炎则是肺。脑部并发症可能源于缺血、出血和/或感染，常常是感染性心内膜炎的首发症状，并且是公认的预后不良因素。感染性心内膜炎仍然是一种可怕的疾病，住院死亡率为20%，5年死亡率为40%，且发病率很高。
