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感染性心内膜炎的诊断及外科治疗

目的　探讨感染性心内膜炎的临床特点、手术时机选择及围术期处理。　方法　回顾分析 2 8例感染性心内膜炎患者手术治疗的临床资料。病因为原发性心内膜炎 2 4例 ,人工心脏瓣膜感染性心内膜炎 4例。施行主动脉瓣置换术 2 0例 ,同期施行右冠状窦破裂自体心包修补和经主肺动脉缝闭未闭动脉导管各 2例 ;二尖瓣置换术 7例 ,其中4例行再次二尖瓣置换术 ;肺动脉瓣置换术 1例。　结果　术后早期死亡 2例 ,随访 2 6例 ,随访时间 3个月至 12年 ,1例术前合并肺部感染 ,术后 6个月因心内膜炎复发死亡 ,1例再次二尖瓣置换术后 2年出现瓣周漏。其余患者疗效良好。　结论　感染性心内膜炎早期诊断、正确选择手术时机、术中彻底清除病灶、合理矫正病变及良好的围术期处理是提高疗效的关键。

先天性心脏病继发感染性心内膜炎的外科治疗

目的 总结先天性心脏病继发感染性心内膜炎41例外科治疗的经验。方法 手术均在体外循环下进行畸形矫正和赘生物清除。室间隔缺损(VSD)直接缝合16例，补片修补10例；动脉导管未闭(PDA)均采用直视缝合法。同期行肺动脉瓣成形术5例，三尖瓣置换术2例，主动脉瓣置换术12例，主动脉瓣和二尖瓣置换术2例。结果 1例急诊VSD修补同时行主动脉瓣置换术，术后并发脑栓塞死亡；其余患者均痊愈出院。随访35例，随访时间3～102个月，无1例死亡和心内膜炎复发。结论 正确把握手术时机和使用有效抗生素是提高治愈率的关键，应强调对先天性心脏畸形的早期治疗，以防止严重并发症。

先天性心脏病合并感染性心内膜炎的外科治疗

目的 总结先天性心脏病（congenital heart disease，CHD）合并感染性心内膜炎（infective endocarditis，IE）的外科治疗经验，以提高诊断、治疗效果。 .方法 .回顾性分析我院73例CHD合并IE患者行瓣膜手术的临床资料，对30例主动脉瓣感染性心内膜炎者行主动脉瓣置换术，另3例行Ross手术。在IE累及二尖瓣21例患者中，行二尖瓣成形术5例，二尖瓣置换术16例；10例主动脉瓣、二尖瓣IE行双瓣膜置换术；对6例肺动脉瓣IE患者行单瓣法做肺动脉瓣成形术2例，肺动脉瓣置换术4例，其中1例同期行主动脉弓置换；3例三尖瓣IE均行三尖瓣置换术。结果 主动脉瓣感染33例(45.2％)，二尖瓣感染21例(28.8％)，肺动脉瓣感染6例(8.2％)，双瓣膜感染10例(13.7％)，三尖瓣感染3例(4.1％)。血培养及赘生物培养总阳性率为23.3％，其中链球菌8例（47.1％），葡萄球菌3例（17.6％）。本组无手术死亡，除1例二尖瓣置换术后1年再次发生IE，拒绝手术治疗外，其余72例患者随访1年均治愈。 结论 CHD应尽早行根治性手术，以避免远期并发IE，损坏心脏瓣膜。对CHD合并IE出现瓣膜关闭不全者应尽快手术，如IE累及二尖瓣、三尖瓣且无瓣膜结构的严重损毁者，施行瓣膜成形术是较好的方法。

感染性心内膜炎合并眼内炎继发黄斑裂孔一例

系统性红斑狼疮患者行二尖瓣成形术一例

感染性心内膜炎的外科治疗

目的 总结感染性心内膜炎(IE)外科治疗的临床经验。 方法 回顾性分析1998年6月至2005年12月收治的23例IE患者外科手术治疗的临床资料，其中先天性心脏病13例，风湿性心瓣膜病7例，原发性细菌性心内膜炎3例。术前16例行血液细菌培养，阳性7例。术前心功能分级(NYHA)II级2例、III级12例、IV级9例。行主动脉瓣置换术4例、二尖瓣置换术4例、主动脉瓣和二尖瓣双瓣膜置换术3例、主动脉瓣、二尖瓣、三尖瓣置换术2例；单纯心内分流修补术8例，主动脉瓣置换加心内分流修补术2例。术后应用足量的敏感抗生素4~6周。 结果 术后第5d和9d分别死亡2例，其中1例因全身肢端和多器官栓塞、脑出血死亡，1例因心脏骤停死亡。术后20例患者心功能恢复至I~II级，治愈出院；1例心功能III级患者好转出院。术后随访19例，随访时间6个月至75年，18例心功能I~II级，1例心功能III级；发生主动脉瓣瓣周漏2例，其中1例于术后3年自愈，1例随访2.6年，无任何自觉症状，心功能I级。 结论 IE经外科手术治疗能取得较好的治疗效果。

Advances in diagnosis and surgical treatment of infective endocarditis

Infective endocarditis (IE) is a disease with severe complications and high mortality. It is heterogeneous in etiology, clinical manifestations, and course. At the same time, there are many disputes on the clinical practice of antibiotic treatment, surgical indications and timing. In this review, we discuss the epidemiology, diagnosis, treatment, and prevention of IE, especially the latest advances in surgical treatment after the release of European Society of Cardiology and American Heart Association guidelines in 2015.

Reoperation after Mechanical Valve Prosthesis Replacement: An Analysis of 105 Cases

Abstract： Objective To summarize our operative experiences of cardiac reoperation after mechanical valve prosthesis replacement and investigate the causes of reoperation and the perioperative techniques and operation methods. Methods From January 2001 to December 2008, we performed reoperation on 105 patients (59 males and 46 females, aged 50.2±10.6 years old) who had undergone mechanical valve prosthesis replacement. Among the patients, there were 31 cases of mitral valvular replacement (+ tricuspid valvular plasticity), 38 cases of aortic valvular replacement (+ tricuspid valvular plasticity), 11 cases of Bentall procedure, 7 cases of mitral and aortic bivalvular replacement (+tricuspid valvular plasticity), 8 cases of tricuspid valvular replacement, 6 cases of repairing of prosthetic leakage, and 4 others cases. The time interval between two operations was 3 months to 18 years (46.3 ±31.9 months). Before reoperation, the cardiac function (NYHA) of the patients was class Ⅱ in 27 patients, class Ⅲ in 53 patients, and class Ⅳ in 25 patients. Results There were 6 hospital deaths with a mortality of 5.71%(6/105). All others recovered to NYHA class ⅠⅡ. The causes of mortality included 1 case of multiple organ failure, 1 case of low cardiac output after operation, 1 case of aortic pseudoaneurysm rupture, 1 case of severe infection due to brain complication and 2 cases of prosthetic valve endocarditis (PVE). The causes for cardiac reoperation after mechanical valve prosthesis replacement were 67 cases of prosthetic leakage (63.80%), 16 cases of PVE (15.23%), 14 cases of prosthetic thrombosis (13.33%) and 8 cases of other valvular anomalies. Followup was done for 11 to 107 months, which showed two cases late deaths of cardiac arrest and cerebral hemorrhage. Conclusion Patients who have received mechanical valve prosthesis replacement may undergo cardiac reoperation due to paravalvular prosthetic leakage, paravalvular endocarditis, and prosthetic thrombosis. The keys to a successful cardiac reoperation include appropriate preoperative preparations, operational timing, and suitable choosing of cardiopulmonary bypass and operational skills. 

先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗

目的　探讨先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗方法和效果。　方法　2009年1月至2012年1月第二军医大学长海医院收治先天性心脏病合并肺动脉瓣感染性心内膜炎患者6例，男1例，女5例；年龄8～41 （24.8±11.8）岁。动脉导管未闭（PDA）4例，PDA合并先天性主动脉瓣狭窄1例，室间隔缺损（VSD）合并三尖瓣反流1例。3例行PDA结扎＋肺动脉内赘生物清除术，1例行PDA结扎＋肺动脉瓣赘生物切除术，1例行PDA结扎＋肺动脉瓣赘生物切除术＋主动脉瓣置换术（AVR，置换19 mm CarboMetics环上机械主动脉瓣），1例肺动脉瓣膜破坏严重，行VSD修补＋右心室流出道赘生物清除＋右心室流出道拓宽＋三尖瓣成形术＋肺动脉生物瓣置换术（置换27 mm HancockⅡ型生物瓣）。　结果　6例患者术后均恢复良好，无围术期死亡和心内膜炎复发。所有患者复查超声心动图提示，未见赘生物、残余漏、瓣周漏等并发症。术后随访6个月～3年中，患者临床症状完全消失，均无明显不适。术后心功能恢复至Ⅰ级5例，Ⅱ级1例。　结论　对于先天性心脏病合并肺动脉瓣感染性心内膜炎患者，正确把握手术时机，积极行外科手术治疗是最有效的治疗方法。

Prosthetic Valve Endocarditis

Abstract: Prosthetic valve endocarditis(PVE) is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. In the past nearly five decades, the microbiology, pathophysiology, clinical features, and therapeutic options in PVE have changed a lot, and there are new insight into the pathogenesis of PVE. The current comprehensive review will address various issues involved in the diagnosis and management of this complication.