Detection rate and clinical significance of latent  infective endocarditis in patients with aortic stenosis

Aim. To evaluate clinical and morphological data of infective endocarditis (IE) of native and prosthetic heart valves.Material and methods. This retrospective cohort study included 354 patients that had signs of IE according to pathological study of surgical material from native valves and prosthetic heart valves. The patients were divided into two groups: the first group included patients with native valve IE (n=328), while the second group — with prosthetic valve IE (n=26).Results. Among patients with native valve IE, aortic (AV) and mitral valve (MV) IE was recorded in 67,6% and 20,7%, respectively. In the group of patients with prosthetic IE, AV IE also predominated — 57,7% vs 26,9% in MV IE. In the majority of patients in the first group, secondary IE was detected (68,9%). The development of IE in the presence of bicuspid AV (BAV), degenerative AV disease, and rheumatic valve disease was revealed in 40,7%, 31,4% and 6,7%, respectively. In the group of patients with native valve IE, subactive IE was most often detected — in 38,4%, while in 7,1% — signs of process remission were detected. In the group of patients with prosthetic valve IE, IE with moderate activity was detected more often than in the group of patients with native valve IE (42,3% vs 26,8%, p=0,042). In the group of patients with prosthetic valve IE, the presence of colonies of microorganisms and neutrophilic infiltration in the histological material was somewhat more common, while in patients with native valve IE there was a tendency towards a higher percentage of necrosis in the studied material (42,4% vs 38,5%, p>0,05).Conclusion. This work confirms changes in the epidemiological characteristics of patients with IE. A high frequency of subactive forms of IE was noted according in patients with native valve IE, which requires individual approach to antibacterial therapy depending on the pathomorphological IE activity.

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Pathomorphological features of complications inpatients with bicuspid aortic valve

Pugina,

Gareev,

Korzhova

et al. 2023

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Purpose: to evaluate the features of the course of complications in patients with BAV based on the results of a pathomorphological study.Material and methods: a retrospective analysis of a register of 328 patients with AS and dilation of the ascending aorta (DAA), based on histological studies performed in 2010–2022 was carried out. 209 patients were diagnosed with BAV as a result of histological examination, and 119 patients were diagnosed with tricuspid aortic valve (TAV). The type of BAV was analyzed in 139 operated patients based on the results of the analysis of surgical protocols.Results: according to the obtained results, the first type with fusion of the right and left coronary cusps prevailed among patients with BAV (78%), the smallest number of patients with BAV was with fusion of the right coronary and non-coronary cusps of the aortic valve (4%), while fusion of the left coronary with the non-coronary cusps of the aortic valve (AV) and patients with "true" BAV occurred in each case in 9% of patients. The formation of AS (75.6%), DAA (68.4%), and the combination of AS+DAA (81%) was more observed in the group of patients with the first type of BAV. According to the results of histology of the AV, there were no significant differences depending on the morphology of the valve. In particular, according to the results of AV histology, the frequency of calcification did not differ in groups of patients with BAV and TAV. Fibrosis with erasing of the layered histoarchitectonics of the AV of varying severity was detected in every second patient, regardless of the presence of congenital heart disease (CHD). According to the results of aortic histology, hemodynamic aneurysm in patients with BAV was much more common than in patients with TAV (p=0.0027). In addition, it was verified that in 39 patients out of 40 without pathomorphological changes in the aortic wall, aortic stenosis appeared in the diagnosis, of which 80% of patients had CHD: BAV. It was verified that 39 out of 40 patients without pathomorphological changes in the aortic wall had aortic stenosis in the diagnosis. Moreover, in 80% of patients, the main cause of aortic dilatation was identified as BAV.Conclusions: the results of this study demonstrated that in the vast majority of cases, aortic dilatation and aortic stenosis are formed during fusion of the right and left coronary cusps. The absence of morphological changes in the aortic wall in almost every third patient with DAA and BAV, confirms the genetic contribution to the formation of aortic dilatation in this category of patients and requires further study.

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Detection rate and clinical significance of latent infective endocarditis in patients with aortic stenosis

Cited by 4 publications

References 13 publications

Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021

Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021

Clinical and morphological features of infective endocarditis of native and prosthetic heart valves

Pathomorphological features of complications inpatients with bicuspid aortic valve

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