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Miliary tuberculosis following homograft valve replacement
Thorax
|February 1, 1976
Summary
This study reports seven cases of miliary tuberculosis following heart valve replacement surgery. Tubercle bacilli were identified on homograft valves, highlighting a rare but serious complication of cardiac surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Complications
Background:
- Infective endocarditis is a known complication of open-heart surgery, particularly after cardiac valve replacement.
- While various pathogens cause endocarditis, tuberculosis has not been previously reported in this context.
Purpose of the Study:
- To describe the clinicopathological features of miliary tuberculosis following homograft valve replacement.
- To investigate the incidence and characteristics of this rare postoperative complication.
Main Methods:
- Review of seven cases of miliary tuberculosis occurring after homograft valve replacement over a five-year period.
- Identification of acid-fast bacilli on valve vegetations, culture, and guinea-pig inoculation for tubercle bacilli.
- Clinical and radiological diagnosis in some cases, including lung biopsy.
Main Results:
- Seven cases of miliary tuberculosis were identified following over 800 homograft valve replacements.
- Tubercle bacilli (human type) were cultured or detected in six of the seven cases.
- Two patients survived with antituberculosis chemotherapy; diagnosis was established during life in three cases.
Conclusions:
- Miliary tuberculosis is a rare but significant complication of homograft valve replacement.
- Standard antibiotic sterilization of homografts may not eliminate tubercle bacilli.
- Early diagnosis and antituberculosis chemotherapy can lead to survival.