Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Result of Surgical Treatment for Infective Endocarditis

심내막염 환자의 수술적 치료성적

  • 최순호 (원광대학교 의과대학 흉부외과학교실) ;
  • 양현웅 (원광대학교 의과대학 흉부외과학교실) ;
  • 이삼윤
  • Published : 1996.02.01
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Abstract

Between January 1986 and June 1994, 23 patients underwent surgical intervention for infective endocarditis at Wonkwang University Hospital. There were 13 male and 5 female, ran ing in age from 13 to 67(mean 43.7 $\pm$ 5.8) years. 21 had native valve endocarditis and 2 had prosthetic valve endocardits. The most common causative organism was streptococci in 9 patients, and the others were staphylococci in 7 patients and unknown in 7 patients. The infection was in the mitral valve in 10 patients, the aortic valve in 6 patients, the aortic and mitral In 5 patients, 2 in tricuspid. Surgical indications for surgery were intractable congestive heart failure, giant growing vegetation and severe valvular insufficiency. There were 3 perioperative death (13%) and no late death. The main causes of death were cerebral embolism in 2 due to recurrent endocarditis and low cardiac output in 1. By NYHA functional classification, all patients were in class III or IV preoperatively, and all patients were improved postoperatively with HYHA functional classification in class I or II. In conclussion, early operative intervention is life-salving in patients with persistent or progres ive congestive heart failure, irrespective of the activity of the infectious process or the duration of antibiotic therapy.

1986년 1월 부터 1994년 7월까지 원광대학병원 흉부외과학교실에서는 23명의 감염성 심내막염 환자를 수술하였다. 남녀의 비는 13:5 이 었고 평균 43.7세 이었다. 분포는 고유판막 심내막염 21례, 인공판막 심내막염 2례이었고 승모판막을 치환한 경우가 16례로 가장 많았고 대동맥 판막 치환술 11례, 삼천판막 치환술 2례 순이었다. 가장 흔한 감염균주는 연쇄상포도구균 이었으나 배양이 않된 경우는 7례나 되었다. 수술대상은 조절되지 않는 심부전증, 거대식균 그리고 판막부전을 보이는 경우이었고, 술후 사망율은 13.4%로 만기사망은 없었다. 사망의 주 원인은 뇌경색증과 저심박출증이었다. 술전 기능등급이 III-IV 이었던 모든 환자는 사망 3례를 제외한 모든 례에서 I-II 등급으로 호전되었다. 결론적으로 조기 수술적 조작은 지속적이거나 진행성 심부전을 갖고있는 환자에서는 감염의 활동성 내지는 항생제 치료의 유무에 관계없이 생명을구할수 있는 방법이다.

Keywords

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