超声心动图实用手册Practical Manual of Echocardiography_部分29精品.pdf

Infective endocarditis | 239 Severe valvular regurgitation the presence of a normal left ventricular size is suggestive of an acute process, prompting surgery [24, 25]. Is indicated in elevated left ventricular end-diastolic or left atrial pressures and moderate-to-severe pulmonary hypertension [15]. Annular or aortic abscess and penetrating lesions (e.g., fistula between the Sinus of Valsalva and the right or left atria or right ventricle, mitral valve perforation with aortic valve endocarditis, infection in the annulus fibrosa) are other Class I indications for surgery [15]. Prosthetic valve involvement is not always an indication for surgery, unless presenting with heart failure, valve dehiscence, abscess formation or worsening regurgitation or obstruction [15]. Vegetation size 10 mm has been associated with a higher risk for embolization [26] and the combination of a size 15 mm with mobility confers an even greater risk [27, 28]. Surgical intervention on this basis alone remains controversial [15]. Prosthetic valve endocarditis Occurs in up to 1–6% of patients with valve prostheses [29, 30] Currently accounts for up to 30% of all cases of endocarditis. Has a higher frequency of abscesses and other paravalvular complica- tions (Figures 17.3 and 17.4) [31]. Figure 17.4 A vegetation is noted (arrow) attached to a prosthetic mitral valve. 240 | Chapter 17 While there are similar rates of infective endocarditis among mechanical and bioprosthetic valves [31], there are basic differences in the appearance of complications: mechanical valves tend to have complications at the site of the junction