Nataf P, Jault F, Dorent R, Vaissier E, Bors V, Pavie A, Cabrol C, Gandjbakhch I
Service de Chirurgie Cardiaque, Hôpîtal de la Pitie, Paris, France.
Eur Heart J. 1995 Apr;16 Suppl B:99-102. doi: 10.1093/eurheartj/16.suppl_b.99.
Severe acute endocarditis can be associated with major destruction of the annulus. Meticulous surgical debridement of friable necrotic material is always necessary and major damage to the annulus of the valve may impair secure seating of the prosthesis. Extra-annular implantation of a prosthesis may be a life-saving procedure when annular implantation is impossible. Between 1978 and 1989, 36 patients underwent extra-annular complex procedures for annular abscesses. The infection involved the aortic prosthesis and the annulus in 22 patients, and the mitral prosthesis and the annulus in 14 patients. In cases of aortic root abscess, a subcoronary valved graft (11 patients), a supracoronary valved conduit (ten patients) or a left ventricle-abdominal aorta valved conduit (one patient) were implanted. In cases of mitral valve endocarditis with extensive annular abscess, intra-atrial insertion of a mitral prosthesis was performed. In such cases, repair of the aortic root with a valved conduit or intra-atrial implantation of a mitral valvular prosthesis can be life saving and can be expected to give excellent long-term results.
严重急性心内膜炎可伴有瓣环的严重破坏。对易碎坏死物质进行细致的手术清创总是必要的，而瓣膜瓣环的严重损伤可能会影响人工瓣膜的牢固固定。当无法进行瓣环内植入时，人工瓣膜的瓣环外植入可能是一种挽救生命的手术。1978年至1989年间，36例患者因瓣环脓肿接受了瓣环外复杂手术。22例患者感染累及主动脉人工瓣膜和瓣环，14例患者感染累及二尖瓣人工瓣膜和瓣环。对于主动脉根部脓肿病例，植入了冠状动脉下带瓣移植物（11例患者）、冠状动脉上带瓣管道（10例患者）或左心室-腹主动脉带瓣管道（1例患者）。对于二尖瓣心内膜炎合并广泛瓣环脓肿的病例，进行二尖瓣人工瓣膜的心房内植入。在这些情况下，用带瓣管道修复主动脉根部或二尖瓣人工瓣膜的心房内植入可挽救生命，并有望获得优异的长期效果。
