Underlying cardiac lesions in adults with infective endocarditis: The changing spectrum

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Abstract

The spectrum of recognized cardiac lesions underlying infective endocarditis has been changing as a result of the decline in incidence of rheumatic heart disease, the recognition of the entity of mitral valve prolapse, and the improvement in cardiac diagnostic techniques. Sixty-three cases of native valve endocarditis diagnosed in Memphis hospitals between 1980 and 1984 were reviewed. All diagnoses of underlying cardiac lesions were confirmed by two-dimensional echocardiography, cardiac catheterization, and/or histopathologic examination of valve tissues. Major categories of underlying lesions were as follows: mitral valve prolapse, 29 percent; no underlying disease, 27 percent; degenerative lesions of the aortic or mitral valve, 21 percent; congenital heart disease, 13 percent; rheumatic heart disease, 6 percent. Thus, mitral valve prolapse and, in the elderly, degenerative lesions have displaced rheumatic and congenital heart diseases as the major conditions underlying endocarditis. Redundancy of the mitral valve leaflets was noted in 17 of 18 patients in whom endocarditis was superimposed upon mitral valve prolapse. The risk of infective endocarditis appears to be substantially increased in the subset of patients with mitral valve prolapse who exhibit valvular redundancy.

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      Citation Excerpt :

      Globally, significant changes have occurred in the epidemiology of IE over the past half-century, especially in the past decade.1 Most of these studies are hospital-based studies and have been performed at large tertiary care referral centers.5-7,10 These studies found an increased mean age at diagnosis and increased male:female ratio as well as a change in microbiology with an increase in the percentage of cases of staphylococcal and enterococcal IE, whereas the percentage of viridans group streptococci and culture-negative IE has markedly decreased.1

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    1

    Dr. McKinsey is the recipient of National Institutes of Health Traineeship Award AI-07238 from the United States Public Health Service.

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