The experimental production of endocardial vegetations as a result of increased work load on the heart is reported by Lillehei1 and associates of the University of Minnesota. In dogs, increased cardiac work load was brought about by large arteriovenous fistulas, such as (a) iliac fistula between the iliac artery and vein, (b) femoral fistula between the femoral artery and vein or (c) aortavena cava anastomosis. Most fistulas were 23 to 40 mm. in length. Two fistulas were usually made in each dog by two operations staged one to four weeks apart.
The physiological effect of such fistulas is lowering of peripheral resistance. This is compensated for by a sixfold increase in cardiac output. The mean carotid pressure is not significantly altered, but the pulmonary artery pressure is increased twofold. There is a twofold increase in plasma volume. Most of the dogs with arteriovenous fistulas died or were killed 100
ENDOCARDITIS FROM HEART STRAIN. JAMA. 1951;145(17):1348. doi:10.1001/jama.1951.02920350042014
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