儿童感染性心内膜炎外科治疗时机

目的 探讨儿童感染性心内膜炎(IE)外科治疗时机。方法 收集儿童IE病例43例。其中合并基础心脏病38例，予手术治疗28例，药物治疗10例；无基础心脏病5例，予手术治疗3例，药物治疗2例。结果 行手术治疗IE者31例，全部治愈；药物治疗12例，近期死亡2例。手术治疗患儿随访27例，无死亡及心内膜炎复发等并发症，生活质量明显提高。结论 儿童感染IE的临床特征和超声心动图的表现与成人患者心内膜炎表现相似，外科手术是治疗IE的有效手段，掌握手术时机是治愈本病的关键。急症手术治疗指征为：心力衰竭恶化，心腔赘生物或瓣膜赘生物大于10mm者，经药物治疗难以控制的感染。儿童感染IE大多数有心脏结构异常，先天性心脏畸形，患儿应早期治疗，以减少IE的发生。

Timing of surgical treatment of infective endocarditis in children

Objective To summarize the experience of the timing of the surgical treatment of infective endocarditis(IE) in children. Methods A total of 43 patients were studied. There were 38 patients with underlying heart disease, including 30 congenital heart disease; 6 rheumatic heart disease; 1 hypertrophic cardiomyopathy, and 1 post-surgery patient of Falot's tetralogy. 28 patients underwent surgical treatment whereas the remaining10 were treated medically. There were 5 patients of IE without underlying heart disease, 4 with post-IE valve lesions; and 1 patient had no valve lesion. Three patients of the latter group underwent surgical treatment while the remaining 2 were treated medically. Results The 31 operated patients all recovered. Two of the 12 patients medically treated died. Conclusions Surgery is an effective treatment of infective endocarditis. Timing of surgery is crucial. Most of the IE children had underlying heart abnormalities.