Vegetative endocarditis in an auricular septal defect

\‘EGETATIVE

ENI>OCXRI)TTIS IN AN X1XI(‘I’IA~ DEFXPT k,F,R

,~J,MOS b-CISXATI.

;kE3OTT,

SISI’TAI,

XT).

OHIO

El :EThTION,S, while common on I he mwgins of the intwrcntricular septal defect, patent ductus 01’ malformcti ralvular oriticc, almost rv3-cr ocww on the intcranr?cula~ septum. ” This const,itutes a In wcmt statement of Maudc E. Abbott’ in a ~wwmal conimllnicntion. her swics of 850 eases of congenital cardiac anomalies, onl,v one case. and that a case of subacult~ bacterial rndocarditis UJ’O~ a low-t~v awicular scptal defect, was found. This rarity has also IwIll stressed by White.’ No rt?port of a substantiated case of an acute l~wcc~ss with fwsh vcgetations has been found by t,he author. FOI- these ~c’asons, the following report of a very unusual 1)athologic picture is pwstntcd.

bb

V

T)uring the progress of experimental investig:ltions u~wn resection of the IOKC~ thirtl of the esophagus. an app:lrently healthy female dog was usetl. The estimatecl age of the dog was -I$$ years, ant1 the wright was ‘70.4 kg. For two weeks ljri()r to operation the animal 1~4 been obserwtl in the isolation room, :wnl altllougll no cardiac studies ha11 been rarriecl out, ttw animal 1~x2 cousitlered to l~c in goor lledtll. Daily rwortls are made of the pulse Iate, rwt:d temper:~ture, an11 respiratory rxte of dogs subjected to this esperimental p~~~w~lure, in or(ler tllat a true preoperxtive base line can be fouml for postoperatiw c~oinparison. The results in this case fell within what was consi~lere~l to he tlw normd for su1~11 11ops: temperature, 300.S to lIE6” E’ . pulse, 9Cb to 1%; respirations, 1S to 24. Under coGhinec1 morphine am1 nrriiln~tal anrdlrsi:c, :I resection of the csxrtli:Lc end of the stomacll xntl the lower ttlirtl of the r~op11:~gus was pvrfornretl. 1)uring this transtlloracic provedurr, the wrlliaz wtilln 1~0uld 1~ .(lirwtly 1111serYc,l am1 was not unusual. No tlirrct pericar~lial or c:lrdiac in,jnry wxs owasionwt 1)y the operzrtion. No untovartl effects from tdther the anestllc~sia or the operxtion IIXW notc~l, ant1 within twenty-four hours the aninlal w:w :ryxin in xpp:“rntly gw11 lwalth. The postoperative course rem:~inell smooth an11 u~l~~o:~l~~li~~~ctc~~l until 111~ fourth pwtqlerative day when the rectal temperatnw rose to 1O::.!!” I?. fro111 :I pre’rious level of 101.6 to 102.1” F.; respirations rwe from 2-i to 36, ant1 @P from 120 to 1::ll. Roentgrnograms am1 pllysical rsanlin~tion of tile vtlest vfnwllwrate(l tire imllression of atelectasis in the louver lobe klf tile lrft Lund. I)i:~gn~~stic~ wpiraticm of the pleurd cavity x&s negatiw. Folloxving tl~ll~‘L.~(~~ltil:~tion, the clinical fimlings tlisappcarell within :L feri l~ours, a1lcI tlLe wurse reni:iine~l unevrntfu I until tlw eighth postoperative day, when a slight woun~t infection w:Ls foun,l. Tllis persiste(l in mil11
B’ig. a.-lnterauricular

cowmunication vegetations

through nbout

which a probe one orifice.

is passed,

Fig. 3.--A. Photomicrograpb of section taken through area showing interauricular and interventricular septa. Portions vegetations are seen. This section is oblique to the channel opening on the left auricular side. T:;;;;est portion of the is distorted by technique in cutting. B, Photomicrograph of area inclosed bs- circle in A, demonstrating and platelets. (X1200.)

and

the fresh

of the septal defect, of valves and large ,and shows only the mteraurlcular septum organisms,

fibrin,