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HERDIN Record #: PCHRDPC011192 Submitted: 16 May 2007 Modified: 04 July 2020

Echocardiographic validation of site of vegetation according to hydrodynamic theory of infective endocarditis.

Dexter Dale L. Briones ,
Homobono B. Calleja,
Benjamin C. Luna ,
Romeo J. Santos

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BACKGROUND: In 1963 Rodbard proposed the hydrodynamic theory of infective endocarditis (IE) to explain the locus of vegetation on the side oriented to the vene contrata. To our knowledge there has been no echocardiographic validation of this theory. The objective of this study is to validate the hydrodynamic theory of IE by determining the loci of vegetation by echocardiography.

METHODS:This is a retrospective-prospective study which includes patients admitted at St. Luke's Medical Center, Makati Medical Center and Philippine Heart Center with a diagnosis of IE by Duke criteria with evidence of vegetation on echocardiography. Patients data were reviewed and transthoracic echocardiogram (TEE) and transesophageal echocardiogram (TTE) were reviewed by 3 independent readers and any disagreement was resolved by consensus. Primary and satellite vegetations locations were noted.

RESULTS: A total of 43 patients were included in the study, 23 males and 20 females. The mean age was 36.8 years with the youngest patients at 1 year and 4 months and the oldest at 86 years. There were 39 patients with valvar endocarditis (VE) and 4 with endocarditis involving a shunt anomaly: 3 ventricular septal defect (SD) and 1 patient ductus arteriosus (PDA). Of the 39 VE, 27 had single valve and 12 had more than 1 valve involvement. All had valvar vegetations. Thirty four had native valve endocarditis and 5 prosthetic valve. A total of 62 vegetations were noted, 50 (81%) were primary and 12 (19%) were satellite lesions. Of the primary lesions, 20 (40%) had mitral valve endocarditis, 18 (36%) aortic valve, 1(2%) tricuspid, 2(4%) pulmonic, 3(6%) prosthetic mitral valve, 2(4%) prosthetic aortic valve. In all 20 mitral VE and 1 tricuspid VE the primary vegetations were located at the atrial side of the mitral valve and tricuspid valve respectively. All 18 aortic and 2 pulmonic VE had primary vegetations at the ventricular side. Four other primary lesions involving a shunt anomaly included 3 vegetations at the right ventricular side of the ventricular septum in 3 VSD and at the pulmonary artery wall in one PDA. In 12 patients with satellite lesions, 5 vegetations were found at the ventricular side of the mitral valve (MV), 4 chordae of the MV, 2 chordae of the tricuspid valve (TV) and 1 pulmonary side of the pulmonary artery side of the pulmonic valve (PV). Satellite lesions at the MV and its chordae had primary lesions at the aortic valve (AV). The vegetation found at the chordae of the TV was associated with a primary vegetation at the PV. The vegetation at the PV. The vegetation at the PV was associated with a primary vegetation at the pulmonary artery wall near the opening of the PDA. Binomial test (p.002) showed a strong association between satellite lesions at the mitral and tricuspid valve with primary lesions at the aortic and pulmonic valves respectively. All 39 patients with VE had regurgitant lesions.

CONCLUSION: This study sustains the hydrodynamic concept of IE by Rodbard. All loci of primary lesions as well as satellite lesions observed by TTE and TEE were in accord of the hydrodynamic concept.

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Publication Date
July-September 1999
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Box No. 44 Fulltext Print Format
Philippine Council for Health Research and Development Fulltext pdf (Request Document)
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