Aortic Valvular Endocarditis Research Articles

The pulmonary vascular lesions of intravenous drug abuse

We examined microscopic sections of lungs from 70 autopsies on persons who abused drugs by intravenous injection in order to evaluate systematically the spectrum of pulmonary vascular lesions resulting from this practice. Angiothrombosis, the most frequent pulmonary vascular lesion, occurred in 13 instances. Morphologic subgroups of this category include weblike and eccentric intimai fibrous lesions, “plexiform-like” lesions, and aneurysmally dilated, tortuous small vessels. Thrombotic changes typically are induced by intravenous injections of solutions derived from tablets or capsules that ethically are intended for oral consumption, because oral pharmaceutical preparations usually contain insoluble microcry-stals such as talc, starch, or cellulose. Ordinary illicit heroin does not contain enough insoluble crystalline debris to induce extensive pulmonary angiothrombosis. We found only two specimens with vascular changes indicative of nonthrombotic pulmonary hypertension; one of these persons had concomitant cirrhosis of the liver, and the other had aortic and mitral valvular bacterial endocarditis. Morphometric studies of the muscular arteries in all other lung samples containing scant embolic foreign material did not show a significant difference between drug abusers and normal control subjects, a finding that fails to support the hypothesis that vasoconstriction or other nonthrombotic reactions to intravenous drug abuse cause pulmonary hypertension and cor pulmonale.

Prosthetic aortic valvular endocarditis.

Infective endocarditis (IE) continues to be one of the most serious complications following cardiovascular surgery, particularly that for replacement of valves. In order to define more clearly the clinical course and the role of surgical therapy, clinical and necropsy data were reviewed in 16 adult patients with prosthetic aortic valvular endocarditis (PAVE) and compared with the experience cited in the literature. Positive blood cultures were obtained in each of the patients with bacterial endocarditis. Gram positive bacteria predominate and the onset of infection is usually later than 25 days postoperatively. In 11 of 16 patients, aortic insufficiency was recognized. Autopsy material demonstrated large perivalvular abscesses which loosened the attachment of the prosthetic valve in each case and which made successful operation unlikely. Aortic insufficiency appears to be of prognostic importance, since patients who developed aortic insufficiency early in the course of PAVE died. Survivors included patients who made an excellent response to medical therapy and who either did not develop aortic insufficiency or developed aortic insufficiency either late in the course or even after cure of PAVE, Poor response to medical therapy and progressive aortic insufficiency even in the absence of left ventricular failure appear to be indications for prompt surgical replacement of the prosthetic aortic valve.

Mitral insufficiency secondary to aortic valvular bacterial endocarditis.

The anterior leaflet of the mitral valve is partly continuous through a fibrous membrane with the aortic valve. Lying immediately subjacent to the aortic valve, the mitral valve and its chordae may become secondarily infected in instances of primary aortic valvular bacterial endocarditis. Destructive changes of the anterior mitral leaflet or mitral chordae may lead to mitral insufficiency. The latter may dominate the functional and clinical pictures. In some instances, when infection is overcome, the clinical picture may appear to be that of primary mitral valvular disease.

Sclerosing mediastinitis and terminal valvular endocarditis caused by fungus suggestive of Aspergillus species.

The case of a 60-year-old woman with the unique combination of fungal sclerosing mediastinitis of at least 12 years’ duration with late onset of aortic valvular endocarditis caused by similar hyphae suggestive of Aspergillus is presented. The patient was maintained in good health by repeated bronchoscopies to relieve bronchial mucoid impactions until her rapid demise after the onset of aortic valvular insufficiency. A brief discussion concerning the relationship of this case to other reported cases is presented.

Aortic Valvular Bacterial Endocarditis in Tetralogy of Fallot Following Blalock Anastomosis: Report of a Case with Complicating Glomerulonephritis

Aortic Valvular Bacterial Endocarditis in Tetralogy of Fallot Following Blalock Anastomosis: Report of a Case with Complicating Glomerulonephritis