Vuille C, Nidorf M, Weyman A E, Picard M H
Cardiac Unit, Massachusetts General Hospital, Boston 02140.
Am Heart J. 1994 Dec;128(6 Pt 1):1200-9. doi: 10.1016/0002-8703(94)90752-8.
Although initial morphologic features of vegetations have been related to the risk of early complications, there is little information about the natural history of the vegetations during medical treatment or the relation of morphologic changes in vegetation to late complications. To assess the evolution of valvular vegetations by echocardiography during treatment of infective endocarditis and to relate the morphologic changes in vegetation to late prognosis, serial echocardiograms of patients with successful medical treatment for native valve infective endocarditis were reviewed to assess the presence and morphologic features of valvular vegetations at the onset and at the end of therapy. The evolution of vegetation size, mobility, consistency, the extent of the disease, and the severity of valvular regurgitation were related to late complications such as embolism, valve replacement, or death occurring after the end of therapy. Forty-one vegetations were identified in 32 patients on initial echocardiograms. At the end of treatment, 29 vegetations were still present; 59% had no significant change in size and 52% appeared to be denser in consistency. Morphologic changes did not relate to late complications, but the presence of severe valvular regurgitations was associated with late valve replacement. The echocardiographic persistence of vegetations is common after successful medical treatment of infective endocarditis. In the absence of severe valvular dysfunction, however, persistent vegetations are not independently associated with late complications.
虽然赘生物的初始形态学特征与早期并发症的风险相关，但关于医学治疗期间赘生物的自然病程，或赘生物形态学变化与晚期并发症的关系，所知甚少。为了通过超声心动图评估感染性心内膜炎治疗期间瓣膜赘生物的演变，并将赘生物的形态学变化与晚期预后相关联，我们回顾了自体瓣膜感染性心内膜炎药物治疗成功患者的系列超声心动图，以评估治疗开始时和结束时瓣膜赘生物的存在情况和形态学特征。赘生物大小、活动度、质地、疾病范围以及瓣膜反流严重程度的演变与治疗结束后发生的晚期并发症（如栓塞、瓣膜置换或死亡）相关。在初始超声心动图检查中，32例患者共发现41个赘生物。治疗结束时，仍有29个赘生物存在；59%的赘生物大小无显著变化，52%的赘生物质地似乎更致密。形态学变化与晚期并发症无关，但严重瓣膜反流的存在与晚期瓣膜置换相关。感染性心内膜炎药物治疗成功后，赘生物在超声心动图上持续存在很常见。然而，在没有严重瓣膜功能障碍的情况下，持续存在的赘生物与晚期并发症并无独立关联。
