Sugimoto T, Ogawa K, Asada T, Mukohara N, Higami T, Obo H, Gan K
Division of Cardiovascular Surgery, Hyogo Brain and heart Center, Himeji, Japan.
Surg Today. 1996;26(9):679-82. doi: 10.1007/BF00312083.
The surgical treatment of nine patients with infective endocarditis (IE) complicated by annular infection and five with IE complicated by cerebral infarction is described herein. In those with annular infection, after thorough débridement of the infected tissues, valve replacement was performed at the original position in five, at the supraannular position in three, and one underwent a translocation procedure. Aortic valve replacement was able to be performed at the original position in two patients by closing the defect at the aortic annulus with a patch after through débridement. The five patients who underwent original valve position replacement recovered well. Of the three who underwent supraannular position replacement, two died of septicemia after a redo operation, and one received pacemaker implantation. The patient undergoing the translocation procedure died of intestinal infarction. In the five patients who suffered cerebral infarction due to embolus of the vegetation, valve replacement was performed between 40 h and 5 months after its onset. Although one patient died of the rapid progression of brain damage, the other four are alive and well, including two who developed mycotic cerebral aneurysm in the infarcted areas. In conclusion, early surgery for IE is mandatory irrespective of active infection, due to the high mortality and morbidity associated with serious sequelae such as annular abscess or cerebral infarction.
本文描述了9例感染性心内膜炎（IE）合并瓣环感染患者及5例IE合并脑梗死患者的外科治疗情况。对于瓣环感染患者，在彻底清创感染组织后，5例在原位置进行瓣膜置换，3例在瓣环上方位置进行置换，1例接受了移位手术。2例患者在彻底清创后用补片封闭主动脉瓣环缺损，从而能够在原位置进行主动脉瓣置换。5例在原瓣膜位置置换的患者恢复良好。3例在瓣环上方位置置换的患者中，2例在再次手术后死于败血症，1例接受了起搏器植入。接受移位手术的患者死于肠梗死。在5例因赘生物栓塞导致脑梗死的患者中，在发病后40小时至5个月之间进行了瓣膜置换。尽管1例患者死于脑损伤的快速进展，但其他4例存活且情况良好，其中2例在梗死区域发生了霉菌性脑动脉瘤。总之，由于与瓣环脓肿或脑梗死等严重后遗症相关的高死亡率和高发病率，无论是否存在活动性感染，IE的早期手术都是必要的。
