Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985-2004)

Mathieu C. Castonguay, Kimberly D. Burner, William D. Edwards, Larry M. Baddour, Joseph Maleszewski

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Few large studies have documented the clinical and pathologic features of native valve endocarditis (NVE) independently from prosthetic valve endocarditis (PVE). Methods: A retrospective study of medical records of all patients undergoing operation for NVE at Mayo Clinic in Rochester, MN (1985-2004), was performed. Medical records were reviewed from 287 patients for demographics, infecting organism, and comorbidities. Microscopic slides from 310 valves were reviewed for features of infection. Results: The study cohort included 287 patients, with age ranging from 9 to 87 years (mean, 54), yielding 310 valves. Most (73%) were from men, and 84% were regurgitant. Risk factors included bicuspid aortic valve (23%), dental manipulation (20%), mitral valve prolapse (18%), diabetes mellitus (16%), and others (< 5% each); in 15%, no risk factor was identified. The four most commonly identified organisms were viridans group streptococci (28%), Staphylococcus aureus (18%), enterococci (9%), and coagulase-negative staphylococci (8%). NVE was histologically active in 58% and healed in 42%, and affected left-sided valves in 94%. It was associated with embolization in 29%, acute heart failure in 29%, and annular abscess in 18%. Men accounted for a higher percentage of aortic NVE than mitral NVE (82% versus 63%, respectively; P=.001). Among 126 valves with active endocarditis, 25% had no microorganisms identified histologically. Conclusion: NVE affected men nearly three times as frequently as women. Diabetes mellitus emerged as a prevalent (and previously underrecognized) risk factor for NVE. The most common infecting organisms were streptococci and staphylococci. Microorganisms were identified histologically in the majority of active endocarditis cases.

Original languageEnglish (US)
Pages (from-to)19-27
Number of pages9
JournalCardiovascular Pathology
Volume22
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Surgical Pathology
Endocarditis
Staphylococcus
Medical Records
Diabetes Mellitus
Viridans Streptococci
Mitral Valve Prolapse
Coagulase
Enterococcus
Streptococcus
Aortic Valve
Mitral Valve
Abscess
Staphylococcus aureus
Comorbidity
Tooth
Cohort Studies
Heart Failure
Retrospective Studies
Demography

Keywords

  • Infective endocarditis
  • Native heart valves
  • Pathology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pathology and Forensic Medicine

Cite this

Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985-2004). / Castonguay, Mathieu C.; Burner, Kimberly D.; Edwards, William D.; Baddour, Larry M.; Maleszewski, Joseph.

In: Cardiovascular Pathology, Vol. 22, No. 1, 01.01.2013, p. 19-27.

Research output: Contribution to journalArticle

Castonguay, Mathieu C. ; Burner, Kimberly D. ; Edwards, William D. ; Baddour, Larry M. ; Maleszewski, Joseph. / Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985-2004). In: Cardiovascular Pathology. 2013 ; Vol. 22, No. 1. pp. 19-27.
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abstract = "Background: Few large studies have documented the clinical and pathologic features of native valve endocarditis (NVE) independently from prosthetic valve endocarditis (PVE). Methods: A retrospective study of medical records of all patients undergoing operation for NVE at Mayo Clinic in Rochester, MN (1985-2004), was performed. Medical records were reviewed from 287 patients for demographics, infecting organism, and comorbidities. Microscopic slides from 310 valves were reviewed for features of infection. Results: The study cohort included 287 patients, with age ranging from 9 to 87 years (mean, 54), yielding 310 valves. Most (73{\%}) were from men, and 84{\%} were regurgitant. Risk factors included bicuspid aortic valve (23{\%}), dental manipulation (20{\%}), mitral valve prolapse (18{\%}), diabetes mellitus (16{\%}), and others (< 5{\%} each); in 15{\%}, no risk factor was identified. The four most commonly identified organisms were viridans group streptococci (28{\%}), Staphylococcus aureus (18{\%}), enterococci (9{\%}), and coagulase-negative staphylococci (8{\%}). NVE was histologically active in 58{\%} and healed in 42{\%}, and affected left-sided valves in 94{\%}. It was associated with embolization in 29{\%}, acute heart failure in 29{\%}, and annular abscess in 18{\%}. Men accounted for a higher percentage of aortic NVE than mitral NVE (82{\%} versus 63{\%}, respectively; P=.001). Among 126 valves with active endocarditis, 25{\%} had no microorganisms identified histologically. Conclusion: NVE affected men nearly three times as frequently as women. Diabetes mellitus emerged as a prevalent (and previously underrecognized) risk factor for NVE. The most common infecting organisms were streptococci and staphylococci. Microorganisms were identified histologically in the majority of active endocarditis cases.",
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