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目的:总结二叶式主动脉瓣畸形合并感染性心内膜炎的临床特点及治疗,明确影响主动脉瓣感染性心内膜炎预后的因素。方法:将2001-01-2010-12期间我院收治的符合DUKE诊断标准的自体主动脉瓣感染性心内膜炎患者98例,分为二叶式主动脉瓣畸形组和三叶式主动脉瓣畸形组,评价临床表现、实验室检查、超声心动图、瓣膜形态、手术治疗与死亡率的相关性。结果:31例(31.6%)二叶式主动脉瓣感染性心内膜炎患者更年轻,易发生瓣周脓肿(35.5%)。二叶式主动脉瓣是瓣周脓肿的独立预测因素(OR=4.015,95%CI 1.307～12.335,P<0.05)。二叶式主动脉瓣畸形组与三叶式主动脉瓣畸形组的早期手术及院内死亡率均差异无统计学意义。严重心力衰竭(OR=8.955,95%CI1.811～44.687,P<0.01)及未控制的感染(OR=0.170,95%CI0.041～0.697,P<0.05)是主动脉瓣感染性心内膜炎死亡的独立预测因素。瓣膜手术可以降低主动脉瓣(OR=0.222,95%CI0.006～0.822,P<0.05)及二叶式主动脉瓣(OR=0.320,95%CI0.090～1.140,P<0.05)感染性心内膜炎的死亡率。结论:二叶式主动脉瓣畸形是主动脉瓣感染性心内膜炎常见的瓣膜异常。二叶式主动脉瓣感染性心内膜炎的患者更年轻,易发生瓣周脓肿。手术治疗可降低二叶式主动脉瓣感染性心内膜炎的死亡率。
OBJECTIVE: To summarize the clinical features and treatment of biliary aortic valve malformations complicated with infective endocarditis, and clarify the factors influencing the prognosis of aortic valve infective endocarditis. Methods: A total of 98 patients with autologous aortic valve infective endocarditis treated with DUKE in our hospital from January 2001 to December 2010 were divided into two-leaf aortic valve malformation group and three-leafed aorta Deformity group, evaluation of clinical manifestations, laboratory tests, echocardiography, valve morphology, surgical treatment and mortality correlation. Results: Twenty-one patients (31.6%) had bilateral aortic valve disease with infective endocarditis and were more likely to develop paravalvular abscess (35.5%). Bipolar aortic valve was an independent predictor of paravalvular abscess (OR = 4.015, 95% CI 1.307 to 12.335, P <0.05). There was no significant difference in early operation and in-hospital mortality between the two-leaf aortic valve malformation group and the three-leaf aortic valve malformation group. Serious heart failure (OR = 8.955,95% CI 1.811 ~ 44.687, P <0.01) and uncontrolled infection (OR = 0.170,95% CI0.041-0.697, P <0.05) An independent predictor of death from membranous inflammation. Valvular surgery could reduce the infection of aortic valve (OR = 0.222, 95% CI0.006-0.822, P <0.05) and the bifacial aortic valve (OR = 0.320, 95% CI0.090-1.140, P <0.05) Endocarditis mortality. Conclusions: Aortic valve deformity is a common valve abnormality of aortic valve infective endocarditis. Patients with bilobed aortic valve infective endocarditis are younger and prone to have perivalvular abscesses. Surgical treatment can reduce the mortality of two-leaf aortic valve infective endocarditis.