Article

lock Open Access lock Peer-Reviewed

4

Views

ARTIGO ORIGINAL

Tratamento cirúrgico do abscesso de anel valvar associado a endocardite bacteriana: resultados imediatos e tardios

Pablo M. A PomerantzeffI; Carlos M. A BrandãoI; Alfredo José MansurI; Ricardo Ribeiro DiasI; Max GrinbergI; Noedir A. G StolfI; Geraldo VerginelliI; Adib D JateneI

DOI: 10.1590/S0102-76381996000100006

RESUMO

No período de outubro de 1978 a dezembro de 1994, ocorreram 619 episódios de endocardite bacteriana em pacientes tratados no Instituto do Coração - HC-FMUSP. Destes, foram operados 208 pacientes e 65 apresentavam abscesso de anel. Quarenta e oito (73,8%) eram do sexo masculino e 17 (26,2%) do feminino. A idade variou de 6 a 61 anos (média de 38,3+/-11,9). Quarenta e seis (70,8%) eram portadores de próteses (36 aórticas e 10 mitráis), 6 (9,2%) apresentavam valvopatia prévia, 1 (1,5%) apresentava cardiopatia congênita e 12 (18,5%) não apresentavam cardiopatia. Os germes predominantes foram: Streptococcus viridans em 17 (26,2%) pacientes, Enterococcus sp em 6 (7,7%) e Staphylococcus aureus em 9 (13,8%). Nove pacientes apresentavam intervalo PR no eletrocardiograma maior que 0,20 mseg no pré-operatório. A indicação da operação foi devida a infecção em prótese em 46 (70,8%) casos, insuficiência cardíaca em 9 (13,8%), falha no tratamento clínico em 5 (7,7%), embolia em 2 (3,1 %), infecção porfungos em 1 (1,5%) e outras em 2 (3,1%). A mortalidade operatória foi de 17 (26,2%) pacientes. Ocorreram 9 (13,8%) óbitos tardios sendo que 5 pacientes faleceram devido a nova endocardite bacteriana. Trinta e sete (86%) pacientes encontram-se em CFI (NYHA), 4 em CF II e 2 CF III no pós-operatório tardio (tempo médio de evolução de 5,3 anos). Os dados apresentados confirmam que a endocardite bacteriana associada a abscesso de anel é doença de alto risco, tem indicação cirúrgica precisa e a evolução tardia demonstra que a maior complicação é a reinfecção.

ABSTRACT

Between October 1978 and December 1994, 619 cases of bacterial endocarditis were treated in the Heart Institute. Of these, 208 were submitted to surgical treatment, and 65 presented abscess in the valvular ring. Forty eight (73.8%) were male, their ages varying from 6 to 61 years, with average of 38.3 +/-11.9 years. Forty six (70.8%) presented a valvular prosthesis (37 aortic and 11 mitral). The microorganisms most commonly found were Streptococcus viridans in 17 (26.2%) patients, Enterococcus sp in 6 (7.7%), and Staphylococcus aureus in 9 (13.8%). Nine patients presented PR interval longer than 0.20 mseg in the pre operative eletrocardiography. The indications for operation were prosthetic valve endocarditis in 46 cases (70.8%), heart failure in 9 (13.8%), failure in clinical treatment in 5 (7.7%), embolism in 2 (3.1%), fungal endocarditis in 1 (1.5%), and others in 2 (3.1 %). The immediate mortality was 17 (26.2%) patients. There were 9 (13.8%) late deaths; of these, 5 presented a new episode of bacterial endocarditis. Thirty seven (86%) patients were in class I (NYHA), 4 in FC II, and 2 in FC III in the late postoperative period, with a mean followup of 5.3 years.These results show that the bacterial endocarditis associated with abscess in the valvular ring is a high risk pathology, the treatment is surgical, and the most common late complication is the reinfection.
Texto completo disponível apenas em PDF.

REFERÊNCIAS

1. Ergin M A, Raissi S, Follis F, Lansman S L, Griepp R B - Annular destruction in acute bacterial endocarditis: surgical techniques to meet the challenge. J Thorac Cardiovasc Surg 1989; 97: 755-63. [MedLine]

2. Mansur A J - Indicações do tratamento cirúrgico em portadores de endocardite infecciosa. Rev Soc Cardiol Estado de São Paulo 1995; 5: 420-7.

3. Stewart W J & Shan K - The diagnosis of prosthetic valve endocarditis by echocardiography. Semin Thorac Cardiovasc Surg 1995; 7: 7-12. [MedLine]

4. Arnoni A S, Almeida A F S, Caceres J F T et al. - Tratamento cirúrgico da endocardite infecciosa. Rev Bras Cir Cardiovasc 1992; 7: 136-44.

5. Jault F, Gandjbakhch I, Chastre J C et al. - Prosthetic valve endocarditis with ring abscesses: surgical management and long-term results. J Thorac Cardiovasc Surg 1993; 105: 1106-13. [MedLine]

6. Lytle B W, Priest B P, Taylor P C - Surgical treatment of prosthetic valve endocarditis. J Thorac Cardiovasc Surg 1996; 111: 198-210.

7. Symbas P N, Vlasis S E, Zacharopoulos L, Lutz J F - Acute endocarditis: surgical treatment of aortic regurgitation and aortico-left ventricular discontinuity. J Thorac Cardiovasc Surg 1992; 84: 291-6.

8. Ergin M A - Surgical techniques in prothestic valve endocarditis. Semin Thorac Cardiovasc Surg 1995; 7: 54-60. [MedLine]

9. Cachera J P, Loisance D, Mourtada A, Castanié J B, Heurtematte Y - Surgical techniques for treatment of bacterial endocarditis of the mitral valve. J Cardiac Surg 1987; 2: 265-74.

10. David T E, Komeda M, Brofman P R - Surgical treatment of aortic root abscess. Circulation 1989; 80 (Suppl 1): 269-74.

11. David T F & Feindel C M - Reconstruction of the mitral anulus. Circulation 1987; 76 (Suppl 3): 102-7.

12. David T E - The surgical treatment of patients with prosthetic valve endocarditis. Semin Thorac Cardiovasc Surg 1995; 7: 47-53. [MedLine]

13. Camacho M T & Cosgrove D M - Homografts in the treatment of prosthetic valve endocarditis. Semin Thorac Cardiovasc Surg 1995; 7: 32-7. [MedLine]

14. Joyce F, Tingleff J, Petersson G - The Ross operation in the treatment of prosthetic aortic valve endocarditis. Semin Thorac Cardiovasc Surg 7:38-46. [MedLine]

15. McGiffin D C & Kirklin J K - The impact of aortic valve homografts on the treatment of aortic prosthetic valve endocarditis. Semin Thorac Cardiovasc Surg 1995; 7: 25-31. [MedLine]

16. Ross D M & Donaldson R M - Homograft aortic root replacement for complicated prosthetic valve endocarditis. Circulation 1984; 70 (Suppl1): 78-81.

17. Danielson G K, Titus J L, Dushane J W - Successful treatment of aortic valve endocarditis and aortic root abscesses by insertion of prosthetic valve in ascending aorta and placement of bypass grafts to coronary arteries. J Thorac Cardiovasc Surg 1974; 67: 443-9. [MedLine]

CCBY All scientific articles published at www.bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY