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感染性心内膜炎合并主动脉瓣周脓肿的外科治疗

Surgical treatment of aortic paravalvular abscess by infective endocarditis

摘要:

目的 总结感染性心内膜炎合并主动脉瓣周脓肿的临床、病理特点及手术治疗经验.方法 对2001年1月至2013年6月接受手术治疗的29例感染性心内膜炎合并主动脉瓣周脓肿患者的临床资料进行回顾性分析.其中男性22例,女性7例;年龄11 ~ 63岁,平均年龄(37±16)岁.基础心脏疾病为先天性主动脉瓣畸形16例,有心力衰竭史15例.主动脉瓣周脓肿病理表现为单纯脓肿型8例,假性动脉瘤样型13例,心内腔室瘘型6例,严重感染形成主动脉左心室离断5例.脓肿位置环上14例,环下10例,环上环下均有5例.血液或术中组织细菌学培养阳性19例,金黄色葡萄球菌9例.采用补片修补瓣周缺损19例,直接缝合10例,同时瓣环重建16例;同期行单纯主动脉瓣置换手术26例,Bentall手术2例;应用人工机械瓣23例,生物瓣5例.结果 全组29例患者,28例治愈出院,1例术后死于败血症.术后随访3个月至13年(平均4.5年),1例非心源性死亡,无心内膜炎复发及瓣周漏.结论 感染性心内膜炎合并主动脉瓣周脓肿并不少见,易发生心力衰竭,根据不同解剖特点选择适合的手术方法可以达到满意的手术效果.

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abstracts:

Objective To summarize the clinical features,pathology and surgical treatment experiences in the patients with aortic paravalvular abscess by infective endocarditis.Methods The study consisted of a retrospective analysis of 29 cases with aortic paravalvular abscess by infective endocarditis underwent surgical treatment between January 2001 and June 2013.Among the 29 patients,22 were male and 7 were female,and the mean age was (37 ± 16) years (range from 11 to 63 years).The primary cardiac disease was congenital aortic valve malformation in 16 patients.There were 15 patients with a history of severe heart failure.Of 29 cases,8 abscess cavities,13 pseudoaneurysms and 6 fistulas were found,and complete aortoventricular discontinuity was present in 5 patients with serious infections.Of them,the abscess was above the annulus in 14 patients and below the annulus in 10 patients,and simultaneously involved the annulus above and below in 5 patients.19 patients were culture positive either positive preoperative blood cultures or positive cultures of surgical specimens,including 9 patients with Staphylococcus infection.The paravalvular defect was repaired by patch in 19 cases,and by local closure in 10 cases.The valvular annulus was reconstructed simultaneously in 16 patients.Aortic valve replacement was performed in 26 patients,and Bentall procedure in 2 patients,including 23 with prosthetic mechanical valve and 5 with biological valve.Results Of the total 29 patients,28 patients were recovered,and 1 patient was died of sepsis.During 3 months to 13 years postoperative follow-up (average 4.5 years),one was died of non-cardiac cause,and no patient had recurrent endocarditis and paravalvular leakage.Conclusions Aortic paravalvular abscess by infective endocarditis is not uncommon,prone to heart failure.According to the different pathological manifestations,the appropriate surgical approach and strategy can achieve satisfactory outcomes.

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