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- 저자 : 황성철 (검색결과 397 건)
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황성철,김준명,이승우,심원흠,조승연,이웅구,조범구,홍승록 대한내과학회 1990 대한내과학회지 Vol.38 No.3
Prosthetic valve endocarditis is an infrequent but a serious complication of cardiac valve replacement associated with unacceptablely high mortality. Although the incidence of prosthetic valve endocarditis may be declining, the absolute number of surgery. However, in Korea, there has been few reports concerning this matter, so we have carried out a clinical analysis of 24 patients with prosthetic valve endocarditis who were diagnosed and treated at Yonsei medical center from January 1980 through December 1988. The overall frequency of prosthetic valve endocarditis was approximately 2.6%. The frequency of early-and late-onset infection was 0.9% and 1.7% respectively. Male to female ratio was 2.4 to 1. There were no predilections as to the anatomic location of the replaced valves or the types of prostheses used in the operation. Common prosenting symptons were fever(79.2%), dyspnea(70. 8%), and anorexia(62.5%). Physical findings were often non-specific and they include newly developed or changing murmurs(66.7%), hepatomegaly(41.7%) and splenomegaly(25.8%). They seldom presented with Osler's node(20.8%), petechiae(16.7%) or Janeway's lesion(12.5%). In addition, abnormal laboratory features include anemia(75.0%), hematuria(62.5%), leukocytosis(50.0%) and non-specific electrocardiographic abnormalities. Vegetations were present in 6 of 17 patients who were examined echocardiographically. Identifiable predisposing factors or the possible sources of indection were dental manipulation or periodontal diseases, osteomyelitis of sternum, wound infection, pneumonia, periodontal diseases, urinary tract infection and infected intravenous catheters. The results of blood culture were positive in 17 of 24 cases(70.8%). Alpha-streptococcus was the most frequently isolated organisms accounting for 29.4% of the positive cultures and was generally associated with a good prognosis. In contrast, Staphylococcus coagulase negative, Pseudomonas aeruginosa, Staphylococcus epidermidis showed high incidence of resistance to conventional antibiotics and consequently resulted in poor prognosis. Complications were congestive heart failure(28.6%), embolism(28.6%), sepsis with shock(14.3%) and acute renal failure(3.6%). Common site of embolism was brain. Overall mortality among patients with prosthetic valve endocarditis was 50.0%; the mortality among patients with prosthetic valve endocarditis were 50.0% and 50. 0% respectively. Medical treatment was carried out in 20 patients and its mortality was 55.0%. Surgical intervention was carried out in 4 patients and it was successful in three cases.
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