Enia F, Bella R, Carmina G, Celona G, Comparato C, Filippone V, Lo Mauro R, Lombardo E, Matassa C, Geraci E
G Ital Cardiol. 1985 Jul;15(7):685-94.
42 consecutive patients with infective endocarditis on native valves, according to Pelletier and Petersdorf's criteria of definite (13 pts), probable (12 pts.) and possible (17 pts) endocarditis, were identified and prospectively followed-up with M-mode and two-dimensional echocardiography, since 1980. We compared: 1) these three groups; 2) survivors not referred for surgery versus surgical patients plus nonsurvivors; 3) patients who suffered embolic events versus those who did not; 4) patients with severe-moderate heart failure versus those with no failure or mild failure; 5) patients with aortic valve echocardiographic vegetations versus those with mitral valve vegetations. Furthermore 11 of these patients who did not undergo surgery (9 with mitral and 2 with mitro-aortic vegetations on echo) were serially followed-up with echocardiography for 6-42 months (average: 32 months). The presence of ultrasound detectable vegetations itself and their size, without considering their site, did not identify a major risk of embolization, heart failure, death or need of surgery. The site of vegetations was the only significant feature in our series. It identified a high-risk group and a relatively low-risk group. Aortic valve involvement, with echocardiographic vegetations, was related to severe or moderate heart failure (P less than 0.01), death or need of surgery (P less than 0.05). Mitral valve involvement carried on a relatively low risk. The 9 patients with mitral valve vegetations only, not referred for surgery and followed-up, did well on medical treatment and returned to work. They did not have relapses or embolization. On serial echocardiographic examinations, mitral vegetations become smaller in the long run. Two years after the acute episode, usually echocardiography did not allow identification of vegetations.
自1980年起，根据佩利捷和彼得斯多夫关于明确（13例）、很可能（12例）和可能（17例）感染性心内膜炎的标准，确定了42例原发性瓣膜感染性心内膜炎患者，并对其进行了M型和二维超声心动图的前瞻性随访。我们比较了：1）这三组；2）未接受手术治疗的幸存者与手术患者加非幸存者；3）发生栓塞事件的患者与未发生栓塞事件的患者；4）中重度心力衰竭患者与无心力衰竭或轻度心力衰竭患者；5）主动脉瓣有超声心动图可见赘生物的患者与二尖瓣有赘生物的患者。此外，对其中11例未接受手术的患者（9例二尖瓣赘生物和2例二尖瓣-主动脉瓣赘生物患者）进行了6至42个月（平均32个月）的系列超声心动图随访。超声可检测到的赘生物本身的存在及其大小，不考虑其部位，并未识别出栓塞、心力衰竭、死亡或手术需求的主要风险。赘生物的部位是我们系列研究中唯一的显著特征。它确定了一个高危组和一个相对低危组。主动脉瓣受累且有超声心动图可见赘生物，与中重度心力衰竭（P<0.01）、死亡或手术需求（P<0.05）相关。二尖瓣受累的风险相对较低。仅二尖瓣有赘生物且未接受手术治疗并接受随访的9例患者，药物治疗效果良好并恢复工作。他们没有复发或栓塞。在系列超声心动图检查中，二尖瓣赘生物从长远来看会变小。急性发作两年后，通常超声心动图无法识别赘生物。
