Инфекционный эндокардит: проблемы диагностики и лечения

Abstract

Results of the clinical study involving 458 patients (from 12 to 75 years, mean age 49 +/- 9.3 years) with various forms of infective endocarditis (IE) have been summarized. Integrated echocardiography was the principal non-invasive method of presurgical diagnosis of the disease. Sensitivity of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were 96% and 97.9% in patients with primary IE, 59% and 92% in patients with secondary IE and 2.7% and 90% in patients with prosthetic endocarditis, respectively. Results of echocardiography were confirmed during intrasurgical revision and histological study of removed valves. However, we have not found correlation between size, location, shape, mobility of vegetations, and risk of embolic events. Integrated echocardiography contributed to the correct diagnosis and also provided the possibility to determine the necessity of surgery and to schedule it in time. The main goals of surgery in IE heart valves are complete removal/sanitation of infected tissue and restoration or replacement of damaged heart valves. Overall hospital mortality was 8.1%. Mortality among patients operated in the active stage of IE and during remission was 10.5 and 7.1%, respectively. Surgical treatment in the active phase of IE is indicated in patients with factors of high risk, when the possibility of cure with antibiotics is unlikely, as well as in patients with high chances of recovery according to the state of organs and systems.