Leport C, Vilde J L, Bricaire F, Frottier J, Dournon E, Verliac F, Bastin R
Eur Heart J. 1984 Oct;5 Suppl C:139-43. doi: 10.1093/eurheartj/5.suppl_c.139.
Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.
在1971年至1980年间所见的296例感染性心内膜炎中，26例患者发生了29例晚期人工瓣膜心内膜炎（10%），这些患者在两个多月前接受了瓣膜置换术。人工瓣膜为二尖瓣的有8例，主动脉瓣的有9例，多个瓣膜的有12例。临床表现始终伴有发热，12例（41%）伴有反流性杂音，7例有脾肿大，13例有神经系统意外，10例有其他心内膜炎体征。血培养28例呈阳性。11例经解剖确诊。确定了31种病原体：15种链球菌（48%），其中大多数为D组（11/15），11种葡萄球菌（35%），6种金黄色葡萄球菌，5种凝固酶阴性葡萄球菌，还有5种其他菌种。记录到2例复发和3例反复感染。死亡率为58%，一些因素与较高死亡率相关：非链球菌微生物（87%）、反流性杂音（83%）、人工瓣膜功能障碍伴心力衰竭（89%）、神经系统并发症（91%）。在抗生素治疗开始后的平均32天内进行了8次瓣膜置换，死亡率为75%。单纯使用抗生素治疗的患者死亡率降至50%，链球菌性心内膜炎患者的死亡率低至23%。这些结果表明，更早期和更频繁的心脏瓣膜置换指征可能是改善预后的一种替代方法。
