Thirty-year incidence of infective endocarditis after surgery for congenital heart defect
Thirty-year incidence of infective endocarditis after surgery for congenital heart defect
复制标题
DOI：
10.1001/jama.279.8.599
复制
发表时间：
1998-02-25
影响因子：
120.7
通讯作者：
Menashe, VD
中科院分区：
文献类型：
--
作者：
Morris, CD;Reller, MD;Menashe, VD
背景-先天性心脏缺陷手术修复后感染性心内膜炎的发生率尚不清楚。目的-确定儿童时期12例先天性心脏缺陷修复后心内膜炎的长期发生率。设计：1982年开始的基于人群的登记。设置。-俄勒冈州。参与者。-从1958年到现在，所有在18岁或18岁以下接受手术修复12例主要先天性缺陷中的一例的俄勒冈州居民。主要结果衡量--医院或尸检记录证实的感染性心内膜炎的诊断。结果-从这一队列3860人中的88%获得了1993年的随访数据。术后25年，法洛四联症、单纯性室间隔缺损、主动脉缩窄、瓣膜狭窄和房间隔缺损的累计感染性心内膜炎发生率分别为1.3%、2.7%、3.5%、13.3%和2.8%。在随访时间较短的队列中，术后20年大动脉右转位的累积发生率为4.0%；10年时，完全性房室间隔缺损的累积发生率为1.1%，室间隔完整的肺动脉闭锁的累积发生率为5.3%，合并室间隔缺损的肺动脉闭锁的累积发生率为6.4%。没有继发孔型房间隔缺损、动脉导管未闭或肺动脉狭窄的儿童术后发生感染性心内膜炎。结论：先天性心脏病手术后心内膜炎的持续发生率，特别是瓣膜主动脉狭窄，值得对先天性心脏病修复术的儿童和成人进行预防心内膜炎的教育。
Context.-The incidence of infective endocarditis after surgical repair of congenital heart defects is unknown.Objective.-To determine the long-term incidence of endocarditis after repair of any of 12 congenital heart defects in childhood.Design.-Population-based registry started in 1982.Setting.-State of Oregon.Participants.-All Oregon residents who underwent surgical repair for 1 of 12 major congenital defects at the age of 18 years or younger from 1958 to the present.Main Outcome Measure.-Diagnosis of infective endocarditis confirmed by hospital or autopsy records.Results.-Follow-up data were obtained from 88% of this cohort of 3860 individuals through 1993. At 25 years after surgery, the cumulative incidence of infective endocarditis was 1.3% for tetralogy of Fallot, 2.7% for isolated ventricular septal defect, 3.5% for coarctation of the aorta, 13.3% for valvular aortic stenosis, and 2.8% for primum atrial septal defect. In the cohorts with shorter follow-up, at 20 years after surgery the cumulative incidence was 4.0% for dextrotransposition of the great arteries; at 10 years, the cumulative incidence was 1.1% for complete atrioventricular septal defect, 5.3% for pulmonary atresia with an intact ventricular septum, and 6.4% for pulmonary atresia with ventricular septal defect. No children with secundum atrial septal defect, patent ductus arteriosus, or pulmonic stenosis have had infective endocarditis after surgery.Conclusion.-The continuing incidence of endocarditis after surgery for congenital heart defect, particularly valvular aortic stenosis, merits education about endocarditis prophylaxis for children and adults with repaired congenital heart defects.