VanHooser D W, Johnson R G, Hein R A, Elkins R C
Ann Thorac Surg. 1986 Aug;42(2):148-51. doi: 10.1016/s0003-4975(10)60508-5.
Aortic valve endocarditis extending beyond the aortic root presents a particularly difficult management problem. During a four-year period we have seen four patients with extensive annular abscesses involving the native valve (in 1 patient) and prosthetic valves (in 3). In all these patients the aortic roots were debrided and valved conduits were replaced with coronary artery grafts while appropriate antibiotics were administered. Postoperative complications included conduction abnormalities, hemorrhage, and low cardiac output, but all 4 patients were discharged from the hospital. Two patients died, 1 of an unrelated disease at 13 months postoperatively and 1 of endocarditis at 16 months postoperatively. The two remaining patients are alive and well at 11 and 46 months postoperatively. We conclude that, in spite of the prosthetic material required, this procedure permits adequate debridement and safe reconstruction for the rare patient in whom endocarditis has resulted in aortic-ventricular discontinuity.
累及主动脉根部以外的主动脉瓣心内膜炎带来了特别棘手的治疗难题。在四年时间里，我们遇到了4例患者，他们均有广泛的瓣周脓肿，累及自身瓣膜（1例）和人工瓣膜（3例）。在所有这些患者中，均对主动脉根部进行了清创，并用冠状动脉移植血管替换了带瓣管道，同时给予了适当的抗生素治疗。术后并发症包括传导异常、出血和低心排血量，但所有4例患者均出院。2例患者死亡，1例在术后13个月死于无关疾病，1例在术后16个月死于心内膜炎。其余2例患者在术后11个月和46个月时存活且状况良好。我们得出结论，尽管需要使用人工材料，但该手术能为心内膜炎导致主动脉-心室连续性中断的罕见患者进行充分的清创和安全的重建。
