Clinical Diagnosis And Surgical Treatment Of 125 Cases Of Congenital Heart Disease Complicated With Infective Endocarditis

Objective By retrospectively analyzed 125 congenital heart disease(CHD) complicated with infective endocarditis(IE) patients, we observed clinical features, therapeutic approaches and surgical effects to discuss how to improve the treatment for those patients.Methods 125 patients who were diagnosed with CHD complicated with IE in The First Affiliated Hospital Of GuangXi Medical University from January of 2010 to December of 2015 were enrolled, we collect their basic information, CHD history, clinical manifestations, ultrasonic cardiogram test, aboratory examination, therapeutic approaches, effects etc.27 patients were treated with only medicine,3 patients who were PDA treated with interventional closure after medical treatment.95 patients were surgical treatment on the basis of the medical treatment.95 patients who were surgical treatment underwent infected tissue excision, deformity correction or valve replacement under cardiopulmonary bypass. The average duration of aortic artery clamp was(79.68±21.56)min, Cardiopulmonary bypass:(109.25±36.43)min, Assisted ventilation:(18.33±6.65)hrs, ICU stay time:(47.53±18.12)hrs.Results In 27 patients with simple medical treatment,5 cases died, and the mortality rate was 18.52%,6 patients were IE recurrence. In 95 patients, who were surgical treatment on the basis of the medical treatment, one patient died of MODS after the surgery,mortality rate was 1.05%, one patient had exploratory thoracotomy for too much drainage after the surgery, one patients was diagnosed with renal insufficiency, one were detected with small residual shunt and one was complicated with third degree AVB. The infection was controlled before these 94 patients discharged and their cardiac function was improved, the length of hospital stay were (29.17±10.52) days. We followed up those patients for 3 months to 6 years after they discharged from hospital, one patients had an relapse and received treatment in hospital, one of them had the infection controlled at last and the other had aortic valve replacement because the severe damage, we collected the information of those patients during following up, according to the NYHA,74 were classified as class I,20 were classified as class II, LAEDD was (48.02±9.52)mm, LVEF was(66.44±10.02)%, they were significantly different compared to the preoperative examinations (P<0.05). The general health, daily life ability, positive attitude postoperative patients score was significantly higher than preoperative, pain and discomfort, on drug dependence was significantly lower than before operation. Differences are statistically significant. The effective rate of surgical treatment of CHD complicated with IE was significantly higher than only medical treatment, the case ineffective rate, fatality rate and recurrence rate was also significantly lower than only medical treatment. It shows that the curative effect of surgical treatment of CHD complicated with IE is better than only medical treatment.Conclusion Individualized project should be based on the medical treatment, the proper timing and approach of surgery wold lower the mortality and improve the effect of the treatment.