[Asymptomatic endocarditis? Are consequent histological studies useful in valve surgery?]

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Pathology

Context:

• Aortic valve replacement is a common procedure for various cardiac conditions.
• Endocarditis requires diligent diagnosis and follow-up antibiotic treatment.
• Preoperative and intraoperative diagnosis of endocarditis in aortic defect cases can be challenging.

Purpose:

• To evaluate the reliability of preoperative and intraoperative diagnostic methods for endocarditis in patients undergoing aortic valve replacement.
• To determine the prevalence of undiagnosed endocarditis in patients with aortic defects requiring valve replacement.
• To assess the utility of histological examination in identifying endocarditis missed by clinical assessments.

Summary:

• Of 187 patients undergoing aortic valve replacement, 150 showed no preoperative or intraoperative signs of endocarditis.
• Histological examination revealed acute florid or chronic lymphocytic endocarditis in 17 patients (Group A), while 133 (Group B) had degenerative valve disease.
• Elevated lactate dehydrogenase (LDH) on postoperative day one was noted in Group A (490 ± 114) versus Group B (403 ± 132, p=0.04).
• 11.3% of clinically asymptomatic patients requiring aortic valve replacement had histological evidence of acute florid endocarditis, undetectable by routine tests.

Impact:

• Histological examination of the aortic valve is essential for identifying a significant percentage of endocarditis cases missed during standard clinical evaluation.
• This study underscores the limitations of current diagnostic methods for endocarditis in this patient population.
• Further research is needed to establish therapeutic guidelines based on histological findings of endocarditis.