Infective endocarditis- (a survey of the past 50 years)

Autopsy incidence of infective endocarditis during the past 50 years was analysed to review the changes in the clinico-pathologic pattern if any. 185 cases were recorded in a total of 39931 autopsies giving an average incidence of 0.46%. The cases were classified into groups I, II & III depending upon whether the endocarditis super-vened on normal hearts, diseased hearts or followed surgery, re-spectively. The fifty year period could be divided into three phases on incidence. First phase (1927-41) represented pre-antibiotic era in which group I cases predominated and causative organisms in 801" o f cases were virulent cocci such as staphylococci, haemolytic streptococci and pneumococci. In the second phase (1948-66) the general incidence was reduced by 50%. Group II cases predominat-ed and the most common etiologic agent was streptococcus viridans (40%). In the third phase (1967-76) the general incidence has reached again to preantibiotic level with coagulase positive staphy-lococci, Gram negative bacilli and fungi accounting for 90% of cases. Group III contributed significantly in this phase. The changes in incidence are primarily due to fall and rise in Group I cases. Incidence of rheumatic heart disease with endocar-ditis which mainly forms Group II is declining steadily in post-antibiotic era. There is no shift in the peak age incidence which remains in the 3rd decade. Males with rheumatic heart disease are more prone to infective endocarditis than similarly affected females. There was no change in frequency of involvement of various valves or sites of embolization

Echocardiographic study of left atrial myxoma

Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio-graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my-xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis-appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma

Fungal endocarditis after cardiac valve replacement

Fungal endocarditis developed in 15 cases out of 205 in whom cardiac valves were replaced during the years 1969-75. Bacterial and fungal infections co-existed in 3 cases. Pure bacterial endo-carditis was seen only in one case during this period. Fungal endo-carditis was not observed following any other type of open or closed heart surgery. Clinicopathologic features of these cases are briefly described. Paucity of clinical signs and symptoms make early diagnosis difficult. The diagnosis of fungal infection was essentially histological. It was corroborated by culture in 3 cases. In 6 cases candida was responsible while in others either Aspergillus or Penicillium was responsible. In 11 out of 15 cases, endocarditis supervened in the early post-operative period stressing the need for vigilance

An unusual instance of mitral valve prolapse in endomyocardial fibrosis

This is a report of an unusual case showing a mitral valve prolapse in the presence of a biventricular endomyocardial fibrosis (EMF). The EMF was strongly suspected on left ventricular angiography and later proved at autopsy. The prolapse of the mitral valve was detected at echocardiography. To the best of our knowledge this is the first report of a case of EMF associated with mitral valve prolapse

Echocardiographic study of left atrial myxoma

Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio­graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my­xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis­appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma