PubMed · 12553088
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Niels Høiby, Keld P Kjeldsen. 2003-01-06. [Current microbiologic strategy in endocarditis].. https://pubmed.ncbi.nlm.nih.gov/12553088/
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Retrospective chart review was undertaken for 480 patients who underwent a total of 506 valve replacements or repair procedures for infective endocarditis. The influence of preoperative antimicrobial treatment on culture, Gram stain, and histopathological examination findings for resected valve specimens was examined. When valves were removed before the end of treatment, organisms were seen on the Gram stain of ground valve material performed in the microbiology laboratory and on Gram-stained histopathological sections in 231 (81%) of 285 and 140 (67%) of 208 specimens, respectively (P=.0007). Gram-positive cocci were either cultured from or observed in excised valve tissue in 42 (67%) of 63 episodes involving negative preoperative blood cultures. Positive Gram stain results for microbiological specimens should be reintroduced into the definite pathological criteria for infective endocarditis. When deciding on how long to continue antimicrobial therapy after valve replacement for endocarditis, valve culture results should be the only laboratory finding taken into account, because it takes months for dead bacteria to be removed from sterile vegetations.
Mitral regurgitation has a complex pathophysiology. It should be assessed from the study of factors influencing regurgitant volume and the evaluation of hemodynamics effects downstream (impact on left ventricular function) and upstream (level of left atrial compliance and pulmonary pressure). The regurgitant volume is larger when the regurgitation time is longer, the regurgitant orifice is bigger and the magnitude of the left ventrico-atrial systolic gradient higher. The study of left ventricular function is difficult, especially in chronic mitral regurgitation where the apparently normal left ventricular systolic function can hide a significant worsening in myocardiacs fibres contractile abilities. With the increase in life expectancy and with the decrease in the incidence of rheumatic fever, aetiologies of mitral regurgitation have changed in the past 30 years. They are now dominated by dystrophic mitral regurgitation and infective endocarditis while rheumatic fever becomes less frequent.