Lesbre J P, Tribouilloy C, Jaubourg M L, Roudaut R, Wolf J, Eicher J C, Denis B, Hadjian O, Lusson J R, Justin E P
Département de cardiologie, CHRU d'Amiens, Salouël.
Arch Mal Coeur Vaiss. 1995 Mar;88(3):321-8.
The authors report the results of a multicenter study which recensed 59 cases (46 men, 13 women, average age 59.8 +/- 14 years) of valve ring abscesses defined by echocardiographic criteria alone (20 cases) or by echocardiographic and/or operative criteria (39 cases). The site of abscess was aortic (53 cases), mitral (5 cases) and tricuspid (1 case). The abscess complicated a prosthetic valve in 34 cases, occurred with a non-pathological valve in 11 cases or a pathological valve in 14 cases. Taking the 39 operated patients as a reference, the diagnostic sensitivity of transthoracic echocardiography was 25% and that of transoesophageal echocardiography: 88%. Bacterial vegetations were diagnosed with a sensitivity of 55% for transthoracic and 88% for transoesophageal echocardiography. The mediocre results of transthoracic echocardiography make transoesophageal echocardiography mandatory when there is a clinical suspicion of abscess: transoesophageal echocardiography should be systematic in prosthetic valve endocarditis and widely employed in native aortic valve endocarditis. The clinical outcome of these cases was: 39 cases were operated: global mortality of 23%, and 18 cases were treated medically, surgery having been declined for various reasons: old age (2 patients), operative risk (1 patient), patient refusal (4 patients), general condition considered to be too good to justify surgery (11 cases, including 6 sterilised abscesses diagnosed some time after the acute infectious phase). The outcome of these 18 patients, who form the biggest non-operated series of valve ring abscesses to date, was studied in detail: 4 died (18% mortality), 1 was operated secondarily for progressive valve dehiscence and 13 had a favourable outcome with an average follow-up period of 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)
作者报告了一项多中心研究的结果，该研究收纳了59例瓣膜环脓肿病例（46例男性，13例女性，平均年龄59.8±14岁），这些病例仅通过超声心动图标准确诊（20例），或通过超声心动图和/或手术标准确诊（39例）。脓肿部位为主动脉瓣（53例）、二尖瓣（5例）和三尖瓣（1例）。34例脓肿并发人工瓣膜，11例发生于非病理性瓣膜，14例发生于病理性瓣膜。以39例接受手术的患者为参照，经胸超声心动图的诊断敏感性为25%，经食管超声心动图的诊断敏感性为88%。经胸超声心动图诊断细菌性赘生物的敏感性为55%，经食管超声心动图为88%。经胸超声心动图结果欠佳，因此当临床怀疑有脓肿时，经食管超声心动图检查必不可少：在人工瓣膜心内膜炎中应常规进行经食管超声心动图检查，在天然主动脉瓣心内膜炎中应广泛应用。这些病例的临床结局如下：39例接受手术，总体死亡率为23%；18例接受药物治疗，因各种原因未进行手术：高龄（2例）、手术风险（1例）、患者拒绝（4例）、一般状况被认为良好无需手术（11例，包括6例在急性感染期后一段时间诊断为已治愈的脓肿）。对这18例患者（构成了迄今为止最大的未手术瓣膜环脓肿系列）的结局进行了详细研究：4例死亡（死亡率18%），1例因瓣膜逐渐裂开而二次手术，13例预后良好，平均随访期为2年。（摘要截选至250词）
