Reitz B A, Stinson E B, Watson D C, Baumgartner W A, Jamieson S W
J Thorac Cardiovasc Surg. 1981 Feb;81(2):212-8.
Aortic prosthetic valve endocarditis is frequently associated with a perivalvular ring abscess which destroys the normal annulus, so that it is difficult to seat a new prosthesis. Between November, 1974, and January, 1980, we treated four patients with aortic prosthetic endocarditis by translocation of the aortic valve, closure of the native coronary artery ostia, and placement of saphenous vein bypass grafts to the coronary arteries. In each case operation was undertaken because of progressive congestive heart failure resulting from aortic regurgitation; two patients had systemic emboli, and two patients had uncontrolled infection. Infection was due to Enterococcus in three instances and to an unknown organism in one. Total ischemic times averaged 2 hours, 15 minutes; a 25 mm Dacron graft containing a porcine valve was used to replace the ascending aorta and aortic valve, and two or three saphenous vein grafts were placed to distal coronary arteries. One patient died 40 days postoperatively of renal failure and Pseudomonas pneumonia with an intact repair. The other three patients were hospital survivors, with one doing well until dying of chronic active hepatitis 12 months postoperatively. The other two patients are alive at 4 months and 18 months with satisfactory hemodynamic function and are free of infection. Translocation of the aortic valve for prosthetic valve endocarditis is a useful alternative when conventional replacement techniques cannot be utilized.
人工主动脉瓣心内膜炎常伴有瓣周脓肿，破坏正常瓣环，导致难以植入新的人工瓣膜。1974年11月至1980年1月期间，我们对4例人工主动脉瓣心内膜炎患者采用了主动脉瓣移位术、封闭自体冠状动脉开口，并将大隐静脉旁路移植至冠状动脉。每例手术均因主动脉反流导致进行性充血性心力衰竭而进行；2例患者发生全身性栓塞，2例患者感染无法控制。3例感染由肠球菌引起，1例由不明生物体引起。总缺血时间平均为2小时15分钟；使用一个含猪瓣膜的25毫米涤纶移植物置换升主动脉和主动脉瓣，并将两到三根大隐静脉移植物置于冠状动脉远端。1例患者术后40天死于肾衰竭和假单胞菌肺炎，修复完好。另外3例患者存活出院，其中1例术后12个月因慢性活动性肝炎死亡前情况良好。另外2例患者分别在术后4个月和18个月存活，血流动力学功能良好，且无感染。当无法采用传统置换技术时，人工瓣膜心内膜炎的主动脉瓣移位术是一种有用的替代方法。
