Prodanov A, Boiadzhiev K, Khekimian A, Kharizanov R, Pavlov Ts
Vutr Boles. 1987;26(1):33-7.
Forty eight cases with infections endocarditis (IE) are analyzed--27 males and 21 females (75% at the age of 31-60). Only in 12.5% IE has developed on intact valvular apparatus. In 83.4% the preceding valvular pathology is rheumatic heart defect (RHD), and congenital cardiac malformations and valvular dysplasia--8.3% each. The mitral-aortic valvular defects predominate in RHD, followed by aortic, tricuspid and mitral ones. In 83.3% X IE is with valvular localization, in 4.2%--parietal and in 12.5%--on valvular prostheses. Vegetations are highly specific for valvular IE (100%) as well as ulcerations (90%) and perforations (45%). Ruptures of extra-valvular structures are established in 8.3%. The inflammatory alterations in myocardium are in 62.5%. The pericardial changes are found in 14.6%, mainly in the cases with valvular prosthesis. Septic changes are established in all cases in the spleen and regeneration of bone marrow, and vascular changes--in 85.4%. The cases with embolism and infarctions predominate in the kidneys (79.1%), followed by the cases with Löhlein's focal nephritis (18.6%). The inflammatory changes in liver are rare--6.9%. In 37.5% changes in brain were established, embolism according to incidence being first, followed by cerebral hemorrhages, cerebral abscesses and purulent leptomeningitis Staphylococcus aureus proved to be most frequent causative infectious agent established et necropsy.
对48例感染性心内膜炎(IE)患者进行了分析,其中男性27例,女性21例(75%年龄在31至60岁之间)。仅12.5%的IE发生于正常瓣膜装置。83.4%的患者先前存在瓣膜病变,为风湿性心脏缺陷(RHD),先天性心脏畸形和瓣膜发育异常各占8.3%。RHD中以二尖瓣 - 主动脉瓣缺陷为主,其次是主动脉瓣、三尖瓣和二尖瓣缺陷。83.3%的IE为瓣膜局部病变,4.2%为心壁病变,12.5%发生于人工瓣膜。赘生物对瓣膜性IE具有高度特异性(100%),溃疡(90%)和穿孔(45%)也是如此。8.3%的患者发生瓣膜外结构破裂。62.5%的患者存在心肌炎症改变。14.6%的患者出现心包改变,主要见于人工瓣膜置换病例。所有病例均出现脾脏的感染性改变和骨髓再生,85.4%出现血管改变。以肾脏栓塞和梗死病例为主(79.1%),其次是Löhlein局灶性肾炎病例(18.6%)。肝脏炎症改变少见(6.9%)。37.5%的患者出现脑部改变,按发生率依次为栓塞、脑出血、脑脓肿和化脓性软脑膜炎。尸检证实金黄色葡萄球菌是最常见的致病感染因子。