Mills S A
Ann Surg. 1982 Apr;195(4):367-83. doi: 10.1097/00000658-198204000-00001.
Infective endocarditis of bacterial or fungal origin may arise in either the left or the right heart and can involve both natural and prosthetic valves. The diagnosis is based primarily upon clinical criteria and positive blood cultures, but serial electrocardiograms, fluoroscopy, and two-dimensional echocardiograms may also be helpful. The initial treatment should consist of antibiotic therapy and is itself often adequate in effecting cure. However, careful observation during antibiotic treatment is mandatory, since the development of congestive heart failure due to valvular obstruction or destruction can be an indication for surgical intervention. Other surgical indications include a failure to respond to antibiotic therapy, pulmonary or systemic emboli, evidence of abscess involving the valvular ring (particularly prevalent with prosthetic valve endocarditis), Brucella infection, and the onset of conduction disturbances. The goals of surgical treatment are removal of infective tissue, restoration of valve function, and correction of associated mechanical disorders. The results are surprisingly good, especially for a condition of this severity.
细菌性或真菌性感染性心内膜炎可发生于左心或右心，可累及天然瓣膜和人工瓣膜。诊断主要基于临床标准和血培养阳性，但系列心电图、荧光镜检查及二维超声心动图也可能有帮助。初始治疗应包括抗生素治疗，其本身往往足以实现治愈。然而，抗生素治疗期间必须仔细观察，因为瓣膜阻塞或破坏导致的充血性心力衰竭可能是手术干预的指征。其他手术指征包括对抗生素治疗无反应、肺或体循环栓塞、有涉及瓣膜环的脓肿证据（人工瓣膜心内膜炎尤为常见）、布鲁氏菌感染及传导障碍的发生。手术治疗的目标是清除感染组织、恢复瓣膜功能及纠正相关机械性紊乱。结果出奇地好，尤其是对于这种严重程度的疾病。
