Hirose S, Nakano K, Kosakai Y, Sasaki T, Kobayashi J, Sasako Y, Yamamoto F, Ueda H, Yutani C, Kitamura S
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka.
J Cardiol. 1998;31 Suppl 1:85-9; discussion 90.
From April 1993 to May 1997, 21 patients underwent surgical treatment for prosthetic valve endocarditis (PVE). There were 13 males and eight females aged from 46 to 79 years old (mean 62 years). There were four cases of early PVE (onset of PVE within 60 days from previous valve replacement), and 17 cases of late PVE (after 60 days). The predominant organisms were Staphylococcus epidermidis (eight cases), Staphylococcus aureus (two cases), MRSA (one case), streptococcal species (three cases), Candida (two cases), Pseudomonas cepacia (one case) and Enterococcus (one case). The predominant organisms were identified in 16 of 20 cases by preoperative blood culture, and in 11 of 20 cases by intraoperative tissue culture, and in 19 cases in all. There were four cases of preoperative cerebral complications, and three cases resurged. The hospital mortality rate was 24% (five patients). Reoperation was required in four patients for recurrence of PVE. Autopsy was performed in four of five patients. Intramyocardial abscess was detected in three patients. Earlier diagnosis and earlier surgical treatment could prevent emboli due to vegetations, which might cause catastrophic results, and could achieve better outcomes. Identification of the predominant organisms, especially from operative tissue cultures, is required.
1993年4月至1997年5月，21例患者接受了人工瓣膜心内膜炎（PVE）的外科治疗。其中男性13例，女性8例，年龄46至79岁（平均62岁）。早期PVE（PVE在先前瓣膜置换术后60天内发病）4例，晚期PVE（60天后）17例。主要病原体为表皮葡萄球菌（8例）、金黄色葡萄球菌（2例）、耐甲氧西林金黄色葡萄球菌（1例）、链球菌属（3例）、念珠菌（2例）、洋葱伯克霍尔德菌（1例）和肠球菌（1例）。20例中有16例通过术前血培养、20例中有11例通过术中组织培养、总共19例鉴定出主要病原体。术前有4例发生脑部并发症，3例复发。医院死亡率为24%（5例患者）。4例患者因PVE复发需要再次手术。5例患者中有4例进行了尸检。3例患者检测到心肌脓肿。早期诊断和早期手术治疗可预防因赘生物导致的栓子形成，赘生物可能会造成灾难性后果，且可取得更好的治疗效果。需要鉴定主要病原体，尤其是通过手术组织培养来鉴定。
