Mitral and Aortic Valvulitis in Primary Chronic Septic Endocarditis

Abstract

Results of long-term prospective follow-up of patients with early stages of mitral and aortic valvulitis and primary chronic septic endocarditic are presented. Clinical diagnostics of the diseases is described and the key role is assigned to pathognomic (absolute) clinical symptoms. The tendency to progressive fibrosis of endocardial structures with subsequent gradual development of valve dysfunction and stenosis (especially for the mitral valve) is revealed. It is shown that early treatment increases the effective valve area and promotes reversion of mitral stenosis. The possibility of early diagnostics of primary chronic septic endocarditis in combination with adequate etiopathogenetic therapy provide the basis for prevention of acquired valvular disease.

Early Echocardiographic Manifestations of Primary Chronic Septic Endocarditis

“…Previously this was detected in patients with mono- [3] and bivalvular valvulitis [12]. A trend to gradual shrinkage of the effective area of AV and tricuspid valve orifi ces was detected, which did not lead to appreciable changes in the hemodynamics during the period of observation.…”

“…They are paralleled by progressive fi brosis of the endocardium with a trend to transition from local involvement to diffuse, involving the valvular and extravalvular compartments, augmenting with time, which is proven by comparison of the data for patients with mono-, bi-, and multivalvulitis. In a previous study, we have noted a stereotypical order of the valvular endocardium involvement: MV valvulitis+AV valvulitis→MV valvulitis+AV valvulitis+tricuspid valvulitis [3,12]. Presumably, the dissemination of fi broplastic involvement of the endocardium depends on the time during which the disease progresses.…”

“…Uncommon clinical, laboratory, and morphological manifestations, maintaining the latent course of the disease, are explained from the viewpoint on primary chronic infl ammation, concomitant with the disease. The results of our many-year study form the base for early clinical recognition of the disease and bring us closer to studies of the early EchoCG manifestations of the process [12].…”

“…A basically different approach to clinical recognition of PCSE making use of pathognomonic extracardial symptoms -the clinical marker pentade -has made possible the early diagnosis, not only before AHD formation, but sometimes even before manifestation of valvular endocardium involvement [2]. Due to this approach it is possible to carry out a prospective observation of patients with initially early stages of the disease during many years and obtain a suffi ciently complete picture of PCSE [3,12]. The debut of the disease, taking place in fact in clinically healthy subjects, proves to be unexpected.…”