Fukunaga S, Akashi H, Tayama K, Egashira A, Aringaga K, Higashi T, Akasu I, Kai E, Kosuga K, Aoyagi S
Second Department of Surgery, Kurume University School of Medicine, Japan.
Kyobu Geka. 1996 Jul;49(8 Suppl):661-4.
Between April 1975 and December 1995, 33 patients with active infective endocarditis underwent surgical treatment at our hospital. The location of diseased valve was shown as ; 18 in aortic, 11 in mitral, and 4 in aortic and mitral position. Of these, 14 patients had an annular abscess or mycotic aneurysm. All patients achieved antibiotic therapy previously, and predominant indication for operation was congestive heart failure. All patients underwent valve replacement. The reconstructive procedures for 14 patients with paravalvular involvement were as follows ; direct closure : 5 cases, direct closure+tilted prosthesis technique : 5 cases, and another 4 cases were, patch closure of VSP resulting from a septal abscess, patch closure+translocation, translocation, and reconstruction of annulas with pericardial patch. There were five (15.2%) operative and hospital deaths and actuarial survival rate was 81% and 61% at 5 and 10 years after operation. Including one who died early after operation, there were 5 cases with postoperative paravalvular leakage and its main cause were persistent infection. In conclusion, it considered that the principles of treating active infective endocarditis is to decide the optimal timing for operation, debride the infected tissue, and close the defect completely.
1975年4月至1995年12月期间，我院对33例活动性感染性心内膜炎患者进行了手术治疗。病变瓣膜的位置显示为：主动脉瓣18例，二尖瓣11例，主动脉瓣和二尖瓣联合病变4例。其中，14例患者有瓣周脓肿或霉菌性动脉瘤。所有患者此前均接受了抗生素治疗，手术的主要指征是充血性心力衰竭。所有患者均接受了瓣膜置换术。14例有瓣周受累患者的重建手术如下：直接缝合：5例，直接缝合+倾斜假体技术：5例，另外4例是，室间隔脓肿导致的室间隔穿孔补片修补术，补片修补+移位术，移位术，以及用心包补片重建瓣环。手术和住院死亡5例（15.2%），术后5年和10年的精算生存率分别为81%和61%。包括1例术后早期死亡患者，有5例术后瓣周漏，其主要原因是持续感染。总之，认为治疗活动性感染性心内膜炎的原则是确定最佳手术时机，清除感染组织，并完全闭合缺损。
