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Implantation of Total Artificial Heart in Congenital Heart Disease
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由于先天性心脏缺陷而经过手术后感染性内心炎的30年发生率
C D Morris1, M D Reller, V D Menashe
1Congenital Heart Disease Research Center, Division of Medical Informatics and Outcomes Research, Oregon Health Sciences University, Portland 97201, USA.
JAMA
|March 5, 1998
概括
传染性内心炎可能发生在童年先天性心脏缺陷修复后很长时间,特别是在膜大动脉狭窄手术后. 对受影响个体而言,对内心炎预防的持续警和教育至关重要.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 心脏外科手术 心脏外科手术
- 传染性疾病 传染性疾病
背景情况:
- 在手术修复先天性心脏缺陷 (CHD) 后,感染性内心炎的长期风险尚未得到充分证实.
- 了解这种风险对于患者管理和预防策略至关重要.
研究的目的:
- 为了确定12个特定的先天性心脏缺陷在儿童时期的手术修复后感染性内心炎 (IE) 的累积发病率.
- 为在经过修复的心血管疾病的患者中提供IE的长期风险分层.
主要方法:
- 使用了 1982 年在俄勒冈州建立的以人口为基础的登记册.
- 该研究队列包括3860名俄勒冈州居民,他们在19岁之前接受了12种主要心血管疾病中的1种手术修复,并于1993年进行了随访.
- 通过医院或尸检记录证实了感染性内心炎的诊断.
主要成果:
- 在手术后25年,累积的IE发病率因缺陷而异:Fallot四重症1.3%,心室隔膜缺陷2.7%,大动脉缩3.5%,膜大动脉狭窄13.3%,初心心膜隔膜缺陷2.8%.
- 其他缺陷在不同后续持续时间显示出不同的发病率,在修复次心室隔膜缺陷,专利导管动脉或肺狭窄后没有报告IE病例.
- 膜大动脉狭窄的累计发病率最高,在25年达到13.3%.
结论:
- 在手术修复先天性心脏缺陷后,存在严重且持续的感染性内心炎风险.
- 门大动脉狭窄的修复带有特别高的长期IE风险.
- 加强患者和医疗保健提供者关于内心炎预防的教育对于已修复的冠心病患者至关重要.
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