Morphologic Findings in Native Mitral Valves Replaced for Isolated Acute Infective Endocarditis





Described here are some clinical and morphological observations in 37 adults having mitral valve replacement for active infective endocarditis limited to the mitral valve. The operatively-excised mitral valves are illustrated in 11 of the 37 patients, and photographs in them show that mitral valve repair in them would have been fruitless. Of the 37 patients, 32 (86%) survived the early operative period (30 days) and 31 (84%) were alive one year after the mitral operation. Of the 37 patients, 34 (92%) appeared to have had anatomically normal mitral valves before the infective endocarditis appeared.


Introduction


In 1993 Fernicola and Roberts described 67 patients studied at necropsy with active infective endocarditis (IE) limited to the mitral valve and none of the 67 patients had undergone mitral valve repair or replacement. All died as a consequence of the mitral valve infection. Of the 67 patients, 42 (67%) had the IE involving a previously normal mitral valve. The present study was prompted by studying 37 patients who underwent mitral valve replacement (MVR) for active IE limited to the mitral valve, of which 34 (92%) appeared to have been anatomically normal valves before the infection. A description of certain clinical and morphologic features in these 37 patients is the purpose of this report.


Patients Studied


Certain clinical and morphologic features in each of the 37 patients are summarized in table 1 . All 37 patients underwent MVR at Baylor University Medical Center from 1998 to 2020 by 12 different cardiac surgeons. All 37 mitral valves were examined, described, weighed and the official report prepared by WCR. The operatively excised mitral valves were fixed in formaldehyde and then photographed (by Saba Ilyas) in 29 cases. Histologic sections of the vegetations were prepared in all 37 patients and both Gram and hematoxylin/eosin stains were examined. The microorganisms infecting each patient were identified by blood culture. Intravenous drug use and symptom onset prior to admission were determined by patient self-reporting. The clinical records were reviewed in all 37 patients. Survival numbers after MVR were those collected from the Social Security Death Index.



Table 1

Patients having replacement of the mitral valve due to active infective endocarditis








































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































Patient No. Age (years) Sex Race Body Mass Index (kg/m^2) Coronary Artery Disease (No. Narrowed) Diabetes Mellitus Intravenous Drug Use (Illicit) Renal Disease Time of Symptom Onset Relative to Operation (Days) Organism Grown at Preoperative Blood Culture Valve Weight (g) Previously Normal Leaflets Posterior Leaflet Excised Embolus (Organ) Mitral Annular Calcium (0-4+) Mitral Valve Prolapse Ruptured Chordae Cuspal Aneurysm Cuspal Perforation Ring Abscess Stainable Organisms Polymorpho-nuclear Leukocytes Fibrin Deposits Calcium 30 Day Survival 1 Year Survival
1 26 F H 21 0 0 0 0 60 None 0.70 + + Br 0 0 + 0 0 0 0 0 + + + +
2 30 F W 21 0 + + 0 <7 MSSA 2.35 + + 0 0 0 0 0 0 0 + + + 0 + +
3 34 M B 26 0 0 0 0 30 Strep. mitis 1.15 0 0 0 0 0 0 0 0 0 + + + + + +
4 35 M H 26 0 + 0 + 90 Staph. epidermidis 4.61 + + 0 0 0 0 0 + 0 + + + 0 + +
5 36 M B 23 0 0 0 0 <7 Strep millerii 3.18 0 0 0 0 0 0 0 0 0 0 + + 0 + +
6 37 M W – 0 0 + + <7 Streptoccoal viridans 2.25 + + Br 0 0 + 0 + 0 0 + + 0 0 0
7 38 F W – + (2) 0 0 + 60 Strep sp. 1.49 + 0 0 0 0 0 0 0 0 0 + + 0 0 0
8 38 F W 21 0 0 0 0 30 Strep sp. 1.61 + + 0 0 0 0 0 0 0 + + + 0 0 0
9 39 F A – 0 0 0 0 <7 Strep millerii 0.68 ?+ 0 0 0 0 0 0 0 0 + + + 0 + +
10 39 M W 23 0 0 0 0 <7 Gamella sanguinis 1.42 + + Br 0 0 0 0 0 0 + + + + + +
11 40 M W 24 0 0 0 0 10 Strep. pneumoniae 0.82 + + Sp 0 0 0 0 + 0 0 + + 0 + +
12 41 M H 24 0 0 0 0 120 None 4.45 + + 0 0 0 + 0 0 0 + 0 + + + +
13 42 F B 331 0 + + 0 – MRSA 1.45 + + 0 0 0 0 0 0 0 + + + 0 + +
14 42 M B 37 0 0 0 + 12 Entero. faecalis 2.10 + + Br 0 0 0 0 0 0 0 0 + 0 + +
15 44 F W 31 0 0 0 0 – None – + 0 0 0 0 0 0 + 0 0 + + 0 + +
16 45 M W – 0 0 + 0 – Strep sp. 5.51 ?+ 0 0 0 0 0 0 0 0 + + + 0 + +
17 45 M B 25 0 0 0 0 – None 0.91 + 0 0 0 0 0 0 0 0 + + + 0 + +
18 48 M W 28 0 + 0 + 20 MRSA 0.30 + 0 0 0 0 + 0 0 0 + + + + + +
19 55 F W 22 0 0 0 0 60 MRSA 0.75 + 0 Br 0 0 0 0 0 0 + + + 0 + +
20 56 F W 32 + (1) + 0 0 <7 Staphylococcus sp. 1.83 + + 0 0 0 0 0 0 0 + + + 0 + +
21 58 F B 28 + (2) 0 0 0 – None 2.12 + + 0 0 0 + + 0 0 + + + 0 0 0
22 58 M W 30 0 0 0 0 30 Strep viridans 1.70 + 0 Br 0 0 0 0 0 0 0 + + + + +
23 59 M B 58 + (2) + + 0 13 Staph aureus 2.30 + 0 0 0 0 0 0 + 0 0 0 + 0 + +
24 59 M W 15 0 0 + + 8 Strep sp. 2.81 + + Br 0 0 0 0 + 0 0 + + 0 + +
25 59 M W 31 0 + 0 +(H) 45 None 1.58 + + 0 0 0 0 0 0 0 0 + + + + +
26 60 F W 33 0 0 0 0 9 Entero. faecium 2.32 + + 0 0 0 0 0 0 0 0 + + + + +
27 60 F W 22 0 0 0 0 30 Staphylococcus sp. 1.07 + + 0 0 0 0 0 0 0 + + + 0 + +
28 61 F W 31 0 0 0 + <7 Strep sp. 2.40 + 0 0 + 0 0 0 + 0 + + + 0 + 0
29 62 M W 24 + (1) 0 0 0 <7 None 0.18 0 + 0 0 + 0 0 0 0 + + + + + +
30 65 M W 29 0 0 0 + <7 Candida Species 2.05 + ? 0 0 0 0 0 0 0 + 0 + 0 + +
31 65 F W 20 0 0 0 0 30 Strep. viridans 1.59 + + 0 0 0 0 0 0 0 + + + 0 + +
32 67 M B 22 0 + 0 0 <7 Strep. bacteremia 3.50 + + 0 0 + + 0 0 0 + + + 0 + +
33 68 M B 42 0 0 0 0 60 B Streptococcus 4.41 + + Br 0 0 0 0 0 0 + + + 0 + +
34 69 F W 23 0 0 0 +(H) <7 MRSA 2.39 + + Br + 0 0 0 0 0 + + + + 0 0
35 72 F W 25 + ? + 0 0 <7 None 3.39 + + 0 + 0 0 0 0 0 0 + + + + +
36 76 M H 21 + (4) 0 0 0 60 None 0.56 + 0 0 0 0 0 0 0 0 + + + 0 + +
37 77 M W 22 + (2) + 0 0 30 Entero. faecium 1.05 + 0 0 0 0 0 0 0 0 + + + + + +
Totals 51 20 23 27 10 10 6 10 40 1.90 32 22 10 3 2 6 1 7 0 24 32 37 12 32 31

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Feb 19, 2022 | Posted by in CARDIOLOGY | Comments Off on Morphologic Findings in Native Mitral Valves Replaced for Isolated Acute Infective Endocarditis

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