The impact of transesophageal echocardiography on the management of prosthetic valve endocarditis: experience of 31 cases and review of the literature.
The impact of transesophageal echocardiography on the management of prosthetic valve endocarditis: experience of 31 cases and review of the literature.
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经食管超声心动图对人工瓣膜心内膜炎治疗的影响：31例经验及文献复习。
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
M. Lengyel
中科院分区：
文献类型：
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作者：
M. Lengyel
研究背景和目的
尽管人工瓣膜心内膜炎（PVE）的预后仍然较差，但早期诊断可能会改善临床结果。本研究旨在评估经食管超声心动图 (TEE) 对 PVE 的诊断能力，并比较并发症发生前后接受治疗的患者的临床结果。
方法
对 31 名患者进行了研究，每名患者均具有根据形态学或临床杜克标准确定的 PVE。患者被分为两组：I组（17名患者）出现PVE临床并发症； II组（14例）无此类临床并发症。各组之间在假体类型、PVE 位置、PVE 类型（早期或晚期）或细菌学检查结果方面没有差异。所有患者均接受经胸超声心动图（TTE）和经食管超声心动图（TEE）； 31 例中有 20 例采用多平面技术进行了后者。
结果
TTE 在 2 例中检测到赘生物，在 4 例中检测到脓肿，而 TEE 在 21 例中检测到赘生物，在 14 例中检测到脓肿。两种技术均在 5 例中发现人工瓣膜阻塞，而 TEE 在 12 例中检测到瓣周漏，TTE 在 9 例中检测到瓣周漏。 TEE 检测到 2 例左心房赘生物。 10 名患者接受了治疗，其中 6 人死亡（所有 5 名患者属于第一组；5 名患者属于第二组）。总共有 21 名患者接受了手术，全部处于活动期。手术死亡率为 38%（第一组 12 例中有 7 例（58%）；第二组 9 例中有 1 例（11%））。
结论
这些研究表明： (i) TEE 为 50% 的病例提供了 PVE 的临床标准； (ii) TEE 有助于在发生充血性心力衰竭和栓塞等并发症之前治疗 PVE； (iii) 在这些并发症出现之前接受手术或药物治疗的患者死亡率显着降低； (iv) 手术不应推迟到出现充血性心力衰竭为止。
BACKGROUND AND AIMS OF THE STUDY
Although prosthetic valve endocarditis (PVE) still has a poor prognosis, early diagnosis may improve clinical outcome. This study was designed to assess the diagnostic ability of transesophageal echocardiography (TEE) in PVE and compare clinical outcome in patients treated before and after the onset of complications.
METHODS
Thirty one patients, each with PVE determined by morphologic or clinical Duke criteria, were studied. Patients were divided into two groups: group I (17 patients) presented with clinical complications of PVE; group II (14 patients) had no such clinical complications. There was no difference between groups in the type of prosthesis, location of PVE, type of PVE (early or late), or bacteriological findings. All patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE); the latter was performed by a multiplane technique in 20 of the 31 cases.
RESULTS
TTE detected vegetations in two cases and abscesses in four, while TEE showed vegetation in 21 and abscess in 14. Prosthetic valve obstruction was found in five cases by both techniques, while paravalvular leak was detected in 12 cases by TEE and in nine by TTE. Left atrial vegetation was detected by TEE in two cases. Ten patients were treated medically, six of whom died (all five who were in group I; one of five in group II). In total, 21 patients were operated on, all in the active phase. The operative mortality was 38% (seven of 12 in group I (58%); one of nine in group II (11%)).
CONCLUSIONS
These studies showed that: (i) TEE provides the clinical criteria of PVE in 50% of the cases; (ii) TEE facilitates the treatment of PVE before the development of complications such as congestive heart failure and embolism; (iii) mortality is significantly lower in patients treated either surgically or medically before these complications develop; and (iv) surgery should not be delayed until congestive heart failure develops.