Wilson W R, Danielson G K, Giuliani E R, Washington J A, Jaumin P M, Geraci J E
Mayo Clin Proc. 1979 Apr;54(4):223-6.
From January 1961 to July 1974, 138 patients underwent cardiac valve replacement because of complications of infective endocarditis. The overall operative mortality was higher in patients with Class IV cardiac functional disability (17%) than in patients with Class III (7%) or II (8%). The mortality for patients who had undergone aortic valve replacement with Class IV disability was higher (22%) than that for patients with Class III (0) or II (6%). When compared with patients without infective endocarditis who had undergone cardiac valve replacement, the operative mortality per valve replacement was approximately the same when the degree of cardiac disability was the same at the time of surgery for both groups of patients. Patients with aortic regurgitant murmurs caused by infective endocarditis should be observed closely for the onset of heart failure, especially during the first month of disease. In patients with aortic or mitral incompetence, if heart failure develops or progresses during the first month, we believe that prompt cardiac valve replacement should be considered, because even heart failure that may initially appear mild often progresses to severe heart failure during this period.
1961年1月至1974年7月，138例患者因感染性心内膜炎并发症接受了心脏瓣膜置换术。IV级心功能不全患者的总体手术死亡率（17%）高于III级（7%）或II级（8%）患者。IV级心功能不全患者接受主动脉瓣置换术的死亡率（22%）高于III级（0）或II级（6%）患者。与未患感染性心内膜炎而接受心脏瓣膜置换术的患者相比，当两组患者手术时的心功能不全程度相同时，每次瓣膜置换的手术死亡率大致相同。由感染性心内膜炎引起主动脉反流杂音的患者应密切观察心力衰竭的发作情况，尤其是在疾病的第一个月。对于患有主动脉瓣或二尖瓣关闭不全的患者，如果在第一个月内出现心力衰竭或心力衰竭加重，我们认为应考虑及时进行心脏瓣膜置换，因为即使最初可能看似轻微的心力衰竭在此期间也常常会进展为严重心力衰竭。
