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Abstract: Objective infective endocarditis vegetations by echocardiography two-dimensional image when the false negative and hemodynamic changes and their significance. Methods Retrospective analysis of 18 cases of false negative echocardiographic vegetations cases ultrasonography, hemodynamics and pathological changes. Results 4 cases of mitral valve and its subsidiary structural damage; 5 cases of aortic valve secondary damage; 1 case of left heart valves are damaged; 2 cases of patent ductus arteriosus; 1 case of patent ductus arteriosus, pulmonary valve prolapse ; 2 cases of ventricular septal defect; 2 cases of ventricular septal defect after re-flow; 1 case of ventricular septal defect associated with lack of the right sinus aneurysm rupture. Conclusion Echocardiography vegetation exists false negative secondary valve damage, hemodynamic changes, which establish the diagnosis of infective endocarditis has important value. Number of pages: 2 page range :14-15 Keywords: Ultrasound echocardiography endocarditis false negative reaction vegetation subject classification: R455.1 [medicine, HEALTH "Clinical Medi Therapeu Physical Therapy (medical Sports)] R542.4 [medicine, HEALTH "within SCIENCES" heart, blood vessels (circulatory) dis Endocardial disease] Related Articles: Topics related references (6) citations (1) coupling the literature (22 articles)
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More Exp Content Document Name: young normal heart infective endocarditis of echocardiography (report of 7 cases) Introduction: Based on 7 cases confirmed by surgery and heart infections of young normal endocarditis (IE) performance of transthoracic echocardiography for analysis and found that IE neoplasm in young normal heart high specificity; edge of the vegetation in the flap is easily identified, and ends at the smaller vegetation chordae Easy is Missing. For the young normal cardiac sudden perforation of valve leaflets and / or support structures should be considered broken by a high degree of vigilance IE. Doppler ultrasound can accurately determine the extent of valve damage caused by IE, and objectively reflect the pathophysiological changes
This paper attempts to make an analysis of the echocardiogram display of the infectious endocarditis (IE) in 7 cases normal cardiac of juveniles.It is found that there is a high specificity of neoplasm in normal cardiac IE of juveniles.The neoplasm located on the valve edge is easy to be distinguished, but the smaller neoplasm located on broken end of chordae tendineae is difficult to be distinguished and may be omitted.It should be considered comprehensively for the proruption of the valve perforation in no . the name of young normal literature infective endocarditis in the heart of the performance of echocardiography (analysis of 7 cases) Article NameArticle From Shanghai Institute of Metallurgy; Materials Physics and Chemistry (Professional) PhD thesis in 2000 Keywords normal heart; infective endocarditis; echocardiography; Keywordsnormal cardiac; infectious endocarditis (IE); echocardiogram.; Echocardiography in evaluation of normal cardiac structure and functionHigh-frequency electric knife, and use the basic principles of
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Infective endocarditis (Infective endocarditis, IE) is due to direct invasion of pathogenic microorganisms endocardial inflammatory diseases with high morbidity and mortality. Congenital heart disease occurs in most patients, based on the normal heart are rare [1], heart valves and easy is the site of involvement, but also found in non-valvular area and into the heart of the mechanical devices, such as artificial valves, pacemakers , implanted defibrillators. In recent years, the results of ultrasound increasing attention has been paid and was listed as an important basis for clinical diagnosis, ultrasound technology has continued to deepen the people's understanding of infective endocarditis.
1 of echocardiography in diagnosis of the role of the IE
Characteristic vegetation, abscess, prosthetic valve dehiscence, or new regurgitation are 4 kinds of IE diagnosis evidence. IE should be suspected in patients with echocardiography, transthoracic echocardiography (TTE) examination is a rapid non-invasive examination methods, the detection of vegetation has a high specificity (98%) [2] However, the sensitivity of detection of vegetation "60%. Diameter of 2mm or more of vegetation, especially in the right heart valve vegetation close to the chest wall easily detected. Suspected IE patients, transthoracic echocardiography alone may cause IE missed some important changes, such as prosthetic valve infection, valve ring abscess, leaflet perforation and fistula, etc. [34]. Children by transthoracic echocardiography sensitive than adults, but in some cases with poor ultrasound penetration, such as fat and muscle development of young people in particular, in patients after cardiac surgery, respiratory functional compensation status, lung over-expansion, transthoracic echocardiography often can not obtain satisfactory results, requires the use of transesophageal echocardiography (TEE) examination.
First reported in 1986, transesophageal echocardiography diagnosis of IE, a large number of studies show that the method in the diagnosis of the disease than by transthoracic echocardiography. IE vegetations on TEE detectors with high sensitivity [5], diagnosis of valvular perforation of high sensitivity [6], involving the valves of the sensitivity surrounding the diagnosis of infection (76% to 100%) and specificity (94%) were higher; diagnosis of prosthetic valve IE vegetation sensitivity of 86% to 94% and a specificity of 88% to 100%, while providing well defined artificial valve regurgitation. TEE can effectively detect complications of left ventricular outflow tract, whether or flap valve, particularly in the development of aortic root abscess and involvement of Valsalva sinus, such complications can cause serious consequences, so the aortic valve endocarditis and TTE aortic root there is a change that all patients should undergo TEE examination. TEE for at least two planes, which can greatly improve the diagnostic sensitivity and reduce false negative results, clearly shows the size and activity level vegetation.
Negative TEE examination can not rule out the formation of a vegetation IE, to clinical and multi-plane transesophageal echocardiography with transthoracic ultrasound detectors to reduce misdiagnosis. When the transesophageal echocardiography and transthoracic ultrasound results were negative, the patient the possibility of the actual negative results of 95%. IE if the high index of suspicion, but no abnormal transesophageal echocardiography, 7 to 10 days should repeat transesophageal echocardiography examination to confirm the existence of previously undetected vegetations and abscesses. Ultrasound follow-up results after treatment showed that 59% of patients with persistent vegetation, and if no serious valvular regurgitation and progressive clinical symptoms, the persistence of vegetation and no correlation between late complications [7]. After a regular course of treatment that if vegetation echocardiography increases, the greatly increased risk of complications.
Should be noted that echocardiography, including TEE has its limitations, echocardiography can not rule out a neoplasm is not seen IE, the opposite mass on ultrasound may also be aseptic thrombosis, aseptic repair materials or similar activities Artificial heart valve pannus mass [8], the normal anatomic variation rather than infectious neoplasms.
2 required surgical treatment characteristics of echocardiography
Echocardiographic changes in the following diseases require prompt surgical treatment (1) vegetation: circulation persistent vegetation after embolization: mitral valve vegetation, especially the vo 10 mm pm; first two weeks of anti-infective treatment occurred 1 thromboembolic events; anti-infection treatment during or after treatment of embolic events anti-infection treatment vegetation volume increase after 4 weeks. (2) valve dysfunction: acute aortic or mitral regurgitation associated with ventricular failure, signs; medical therapy of heart failure; valve perforation or rupture. (3) around the affected valve: valve cracks, rupture or fistula; emerging heart block; proper anti-infection treatment after a large abscess or abscess sp.
3 of echocardiography in IE concurrent congestive heart failure (CHF) in the role of
The complications in IE, CHF greatest impact on prognosis. Natural valve IE in patients with acute CHF occurred in the aortic valve infection (29%), followed by mitral valve (20%) and tricuspid valve (8%). Patch of natural or biological valve leaflet perforation, infection of the mitral valve chordae rupture, valve obstruction caused by a huge cause of vegetation can cause acute CHF. CHF can also be hidden place, from valvular regurgitation and ventricular dysfunction caused by progressive deterioration. IE the early diagnosis of normal or only mild ventricular function in patients with CHF may develop during treatment severe CHF, treatment of the first month of 2 / 3 of patients will be. IE medical treatment in patients with CHF indicate a poor prognosis, the efficacy of surgery are also poor. If the delay to surgery when ventricular decompensation, greatly increasing the surgical mortality. Echocardiography can help us understand the situation of IE in patients with CHF, ventricular size, wall mobility and hemodynamic function by echocardiography is relatively easy to define and quantify valvular regurgitation. Expansion of the cardiac chamber, pulmonary artery pressure and increased wall stress are meant to decompensation direction. Echocardiography to guide medical and surgical treatment options, IE determine whether surgery in patients with CHF, based primarily on the severity of grading standards in accordance with New York Heart Association, heart function class III or IV CHF, renal hypoperfusion and age operations are not too large. Valve implantation in patients with active IE again after the infection rate of about 2% to 3%, the mortality rate is far lower than the control of CHF. Whether patients with CHF in IE valve surgery should be based on degree of injury and the condition of the surrounding structures, and severe valvular rupture of prosthetic valve replacement done, there are also reports of successful valve repair. Leaflets perforation protection if the lobules around well and can be used to maintain the activities of a small pericardial valve with patch. Some patients with aortic or dispersed in the vegetations on the mitral valve leaflets can be organized along the following leaflet resection and repair with a patch. In short, the experience so far is not much vegetation removal.
4 predict the risk of thrombosis
Tissue embolism in patients with IE was 22% to 50%. Thrombosis often occurs in the main artery vascular bed, such as lung, coronary artery, spleen, intestine and limbs. Embolism involving the central nervous system up to 65%, central nervous system is more than 90% occlusion of middle cerebral artery, which can cause high mortality. Embolism can occur in a clear diagnosis before treatment, during or after treatment, most of the embolism occurred in the beginning of anti-infection therapy 2 to 4 weeks. Some use of transthoracic echocardiography studies have shown that left ventricular vegetation diameter greater than 1cm higher rates of embolism occurs [9], transesophageal echocardiography showed mitral valve vegetation diameter greater than the rate of 1cm thrombosis high, but studies have shown that between vegetation size and embolic no clear correlation. In short, the mitral valve vegetation size regardless of size, risk of thrombosis (25%) than in aortic (10%), attached to the mitral valve thrombosis in the proportion of vegetation (37%) than after leaves.
5 Diagnosis of valve ring around the spof infection
Spthe range of IE beyond the valve ring indicates a high mortality rate, more susceptible to CHF, required surgery. Aortic valve endocarditis often violations of the weakest parts of Central, the area near the membranous intervals and atrioventricular node, the anatomical features means prone to abscess and heart block. Valve ring around the involvement of the more common, accounting for 10% of valvular IE 40%, and aortic valve IE than the more common mitral and tricuspid valve IE. IE caused by artificial replacement heart valve annulus surrounding the infection is particularly noteworthy, the rate was 56% to 100% [10]. Artificial heart valve replacement valves are particularly common around the abscess, because the valve leaflets is a ring rather than the primary site of infection. Intravascular pressure in the systemic circulation under the effect of fistula abscess may develop, causing cardiac or pericardial shunts. Clinical data often can not rely on IE to determine spto the valve around the anti-infection after treatment by sustained bacteremia or fever, recurrence of embolism, heart block, CHF, or the emergence of new pathological heart murmur is often prompted the spof infection. ECG appearance of new atrioventricular block on the abscess, 88% positive predictive value, but low sensitivity (45%). The size of vegetation around the valve can not be used to predict the spof infection. Transthoracic echocardiography sensitivity of detectors, the low valve abscess; transesophageal echocardiography in the spof IE valve ring around the high sensitivity (76% -100%), specificity is high (95%), the positive and negative predictive values were 87% and 89%, can serve as a preferred method of examination.
Small spof infection around the valve ring and myocardial abscess can be used non-surgical treatment methods, such as not associated with heart block, echocardiographic abscess during the treatment period to further develop the evidence, valve rupture or reflux. These were subject to close monitoring of transesophageal echocardiography, anti-infection treatment 2,4,8 weeks after the first repeat transesophageal echocardiography.
6 Prognosis
The child mortality rate of about 20% of patients to 40%, the highest death rates one month after discharge, followed by relatively stable. Cardiac causes of death accounted for about 1 / 3, mainly for CHF and sudden death, mitral and aortic valve disease no difference in long-term survival. Delahaye et al [11] found no persistent fever, the male, valve repair, older age, follow-up during the CHF, surgical delay, Staphylococcus aureus or other non-streptococcal infection, acute or complicated disease can be used as an independent predictor of poor prognosis. Some laboratory tests such as abnormal white blood cell count and albumin, the average C-reactive protein concentration [12], serum creatinine concentration, abnormal heart rhythm, there are two main indicators of Duke criteria, the initial echocardiography is vegetation can be seen [13] and so can be used as a predictor of poor prognosis.
Rising incidence of IE, each year increase of 15 000 to 20 000 patients, and now IE has become the fourth life-threatening infections (following the urinary sepsis, pneumonia and intra-abdominal sepsis after). Although anti-infective therapy, diagnostics and surgical technology have made some progress in reducing the incidence of the disease and mortality, but still on people's life constitutes a potential threat. Echocardiography will help us correct diagnosis of the disease, timely detection and treatment of major complications such as heart failure IE, infection spto the valve ring around and so on is essential to obtain good therapeutic effect.



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