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August 1952

PATHOGENESIS OF VALVULAR ENDOCARDITIS: I. Production of Acute Cardiac Valvular Lesions by a Large Arteriovenous Shunt II. Effects of an Arteriovenous Shunt on Removal of Bacteria from the Blood Stream

Author Affiliations

From the Division of Thoracic Surgery and the Department of Medicine, Duke University School of Medicine.

AMA Arch Surg. 1952;65(2):271-275. doi:10.1001/archsurg.1952.01260020284009

THE FACTORS underlying the pathogenesis of valvular endocarditis may be divided into two large groups, those related to valvular disease and those related to the entrance of bacteria into the valvular lesion. In studying this problem, Nedzel1 reported that valvular lesions occurred in dogs from the repeated use of vasopressin injection (pitressin®). Trauma, due to an increased cardiac work load during the pressor episodes, was advanced as the important initiating factor in that it caused endocardial damage which then served as a nidus for the development of infection. Lillehei, Bobb, and Visscher2 reported endocardial lesions and bacterial infection of those lesions in animals with arteriovenous fistula.

The present study was undertaken to further understand the nature of these valvular lesions and to determine the effect of the altered circulation incident to these large arteriovenous fistulae on the ability of the animal to remove bacteria from the blood stream.