Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.
Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.
J Am Heart Assoc. 2020 Aug 4;9(15):e017293. doi: 10.1161/JAHA.120.017293. Epub 2020 Jul 23.
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
与大量关于左侧感染性心内膜炎（IE）的资料相比，有关右侧 IE 的特征和处理的资料则要少得多。右侧 IE 占所有 IE 病例的 5%至 10%，与左侧 IE 相比，它更常与静脉内药物使用、心内装置和中心静脉导管相关，所有这些在过去 20 年中变得更加普遍。在这篇关于右侧 IE 的文章中，我们提供了有关右侧 IE 的最新流行病学、病因学、微生物学、右心感染的潜在部位、诊断、影像学、常见并发症、处理和预后的概述。我们提供了有关起搏器和装置感染治疗的最新信息，以及在中心静脉导管后似乎是容易被忽视的感染源的感染性纤维鞘。我们回顾了 AngioVac 经皮抽吸装置的最新数据，该装置可避免对感染性起搏器导线和纤维鞘的患者进行手术。我们还重点介绍了正电子发射断层扫描/计算机断层扫描等先进的诊断方式。所有这些都得到了我们经验中详细超声心动图成像的具体病例示例的支持。
