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先天性心脏病患者经导管肺动脉瓣植入术后感染性心内膜炎:特征。

Infective endocarditis after transcatheter pulmonary valve implantation in patients with congenital heart disease: Distinctive features.

机构信息

Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Clinical Microbiology Laboratory, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France.

Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France.

出版信息

Arch Cardiovasc Dis. 2023 Mar;116(3):159-166. doi: 10.1016/j.acvd.2023.01.008. Epub 2023 Feb 17.

Abstract

The introduction of transcatheter pulmonary valve implantation (TPVI) has greatly benefited the management of right ventricular outflow tract dysfunction. Infective endocarditis (IE) is a feared complication of TPVI that affects valve durability and patient outcomes. Current recommendations provide only limited guidance on the management of IE after TPVI (TPVI-IE). This article, by a group of experts in congenital heart disease in children and adults, interventional cardiology, infectious diseases including IE, and microbiology, provides a comprehensive review of the current evidence on TPVI-IE, including its incidence, risk factors, causative organisms, diagnosis, and treatment. The incidence of TPVI-IE varies from 13-91/1000 person-years for Melody valves to 8-17/1000 person-years for SAPIEN valves. Risk factors include history of IE, DiGeorge syndrome, immunosuppression, male sex, high residual transpulmonary gradient and portal of bacteria entry. Staphylococci and streptococci are the most common culprits, whereas Staphylococcus aureus is associated with the most severe disease. In addition to the modified Duke criteria, a high residual gradient warrants a strong suspicion. Imaging studies are helpful for the diagnosis. Intravenous antibiotics guided by blood culture results are the mainstay of treatment. Invasive re-intervention may be required. TPVI-IE in patients with congenital heart disease exhibits several distinctive features. Whether specific valve types are associated with a higher risk of TPVI-IE requires further investigation. Patient and parent education regarding IE prevention may have a role to play and should be offered to all patients.

摘要

经导管肺动脉瓣植入术(TPVI)的引入极大地改善了右心室流出道功能障碍的治疗。感染性心内膜炎(IE)是 TPVI 的一种可怕并发症,会影响瓣膜的耐久性和患者的预后。目前的建议仅为 TPVI 后 IE(TPVI-IE)的管理提供了有限的指导。本文由一组儿童和成人先天性心脏病、介入心脏病学、包括 IE 在内的传染病以及微生物学专家撰写,全面回顾了关于 TPVI-IE 的现有证据,包括其发病率、危险因素、病原体、诊断和治疗。TPVI-IE 的发病率因瓣膜类型而异,从 Melody 瓣膜的 13-91/1000 人年到 SAPIEN 瓣膜的 8-17/1000 人年不等。危险因素包括 IE 病史、DiGeorge 综合征、免疫抑制、男性、残余跨肺梯度高和细菌入口。葡萄球菌和链球菌是最常见的病原体,而金黄色葡萄球菌与最严重的疾病有关。除了改良的杜克标准外,高残余梯度强烈提示该病。影像学研究有助于诊断。根据血培养结果静脉应用抗生素是治疗的主要方法。可能需要进行侵入性再干预。先天性心脏病患者的 TPVI-IE 表现出一些独特的特征。特定的瓣膜类型是否与更高的 TPVI-IE 风险相关需要进一步研究。应向所有患者提供针对 IE 预防的患者和家长教育。

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