Li W, Somerville J
Grown-up Congenital Heart Unit, Royal Brompton Hospital, London, U.K.
Eur Heart J. 1998 Jan;19(1):166-73. doi: 10.1053/euhj.1997.0821.
Infective endocarditis accounts for 4% of admissions to a specialized unit for grown-up congenital heart patients. This study defines lesions susceptible to infection, antecedent events, organisms, outcome and surgical treatment in a group of such patients.
The grown-up congenital heart disease database was searched for all patients aged 13 years and above with adequate documentation of infective endocarditis retrospectively between 1983-1993 and thereafter between 1993-1996. There were 185 patients (214 episodes) divided into Group I: 128 patients unoperated or palliated and Group II: 57 patients after definitive repair and/or valve repair/replacement. In Group I, the commonest affected sites were ventricular septal defect in 31 (24%), left ventricular outflow tract in 22 (17%) and mitral valve in 17 (13%) and in Group II, left ventricular outflow tract in 20 (35%), repaired Fallot in 11 (19%), and atrioventricular defects in eight (14%). Infective endocarditis was not seen in secundum atrial septal defects before or after closure; in closed ventricular septal defects and ducts without left-sided valve abnormality; in isolated pulmonary stenosis; in unrepaired Ebstein: or after Fontan-type or Mustard operations. Surgery was performed in 39 patients: as an emergency in 17, and for failed medical therapy in 22. Only 87 (41%) of patients had a predisposing event: dental procedure or sepsis were the commonest events in Group I (33%) and cardiac surgery in Group II (50%). Streptococci species were found in 54% of Group I patients and in 45% of Group II. Staphylococci aureus was commoner in Group II (25%) compared to Group I (14%). Mean time from the onset of symptoms to diagnosis was 60 and 29 days in Groups I and II, respectively. Eight (4%) patients died as a result of septicaemia related to emergency or repeated surgery and Staphylococcus aureus infection. Recurrent attacks occurred in 21 (11%) patients.
Reparative surgery does not prevent endocarditis except for closure of a ventricular septal defect and duct. Delay in diagnosis is serious since it contributes to mortality, although the overall mortality % is not high. Specific lesions are not affected so prophylaxis is probably unnecessary in those anomalies.
感染性心内膜炎占成年先天性心脏病患者专科病房入院人数的4%。本研究明确了一组此类患者中易感染的病变、前驱事件、病原体、结局及外科治疗情况。
回顾性检索成年先天性心脏病数据库中1983 - 1993年及之后1993 - 1996年所有年龄在13岁及以上且有充分感染性心内膜炎记录的患者。共有185例患者（214次发作），分为I组：128例未接受手术或姑息治疗的患者；II组：57例接受确定性修复和/或瓣膜修复/置换的患者。在I组中，最常受累部位为室间隔缺损31例（24%）、左心室流出道22例（17%）和二尖瓣17例（13%）；在II组中，左心室流出道20例（35%）、法洛四联症修复术后11例（19%）和房室间隔缺损8例（14%）。继发孔型房间隔缺损封堵前后均未发生感染性心内膜炎；在无左侧瓣膜异常的闭合性室间隔缺损和动脉导管；孤立性肺动脉狭窄；未修复的埃布斯坦畸形；或在Fontan型或Mustard手术后。39例患者接受了手术：17例为急诊手术，22例为药物治疗失败后手术。只有87例（41%）患者有诱发事件：牙科手术或败血症是I组中最常见的事件（33%），心脏手术是II组中最常见的事件（50%）。I组54%的患者和II组45%的患者发现链球菌属。与I组（14%）相比，金黄色葡萄球菌在II组中更常见（25%）。I组和II组从症状出现到诊断的平均时间分别为60天和29天。8例（4%）患者因与急诊或重复手术及金黄色葡萄球菌感染相关的败血症死亡。21例（11%）患者复发。
除室间隔缺损和动脉导管闭合外，修复性手术不能预防心内膜炎。诊断延迟很严重，因为它会导致死亡，尽管总体死亡率不高。特定病变不受影响，因此在这些异常情况下可能无需预防。
