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...gnosis of infective endocarditis, when these specimens are available [5]. Histological findings are included in the Duke criteria and are considered to be criteria of confirmed infective endocarditis =-=[4, 10]-=-. These include the histological demonstration of microorganisms in a vegetation or intracardiac abscess as well as pathologic lesions, such as vegetations, and active endocarditis at the histological...

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...urgical repair of cardiac valves has become the therapy of choice for a great number of patients with heart valve dysfunction, because it offers them a higher survival rate and better quality of life =-=[1]-=-. Among the types of prosthetic cardiac valves, bioprostheses are preferred to mechanical valves in patients who are elderly, have a life expectancy of !10– 15 years, or cannot take anticoagulant ther...

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...ical diagnostic abilities [2, 3]. The current approach to the treatment of patients with suspected bioprosthetic valve endocarditis is determined by the higher sensitivity of diagnostic Duke criteria =-=[4]-=-, among which echocardiography used to detect vegetations and blood cultures done to isolate the causative organism are routinely performed. However, although transesophageal echocardiography has exce...

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...Infectious Diseases 2006; 42:590–6 2006 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2006/4205-0002$15.00 often challenges physicians’ clinical diagnostic abilities =-=[2, 3]-=-. The current approach to the treatment of patients with suspected bioprosthetic valve endocarditis is determined by the higher sensitivity of diagnostic Duke criteria [4], among which echocardiograph...

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... [15– 18]. Infection of implanted bioprostheses continues to be a major complication of cardiac valve replacement, and the casefatality rate remains high despite modern medical and surgical therapies =-=[1, 19, 20]-=-. The precise features that characterize histological infective endocarditis are not accurately standardized [4, 21]. To achieve this standardization, we analyzed a larger number of bioprosthetic valv...

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...getations and microorganisms does not exclude the histological diagnosis of infective endocarditis as some of us and our colleagues showed with a study of Q fever endocarditis in bioprosthetic valves =-=[25]-=-. Finally, adherent thrombi can occur to the surface of bioprostheses as noninfective degenerative phenomena [15, 26]. These vegetation-like structures could be misdiagnosed as vegetations by echocard...

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...Infectious Diseases 2006; 42:590–6 2006 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2006/4205-0002$15.00 often challenges physicians’ clinical diagnostic abilities =-=[2, 3]-=-. The current approach to the treatment of patients with suspected bioprosthetic valve endocarditis is determined by the higher sensitivity of diagnostic Duke criteria [4], among which echocardiograph...

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...ty for vegetations, infective endocarditis is sometimes devoid of vegetations or, in contrast, some degenerative changes that commonly occur in bioprosthetic valves can be misdiagnosed as vegetations =-=[5]-=-. On the other hand, and despite improved culture methods, the results of blood cultures for endocarditis may be negative if the patient has recently received antibiotics or if the organism is fastidi...

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...he casefatality rate remains high despite modern medical and surgical therapies [1, 19, 20]. The precise features that characterize histological infective endocarditis are not accurately standardized =-=[4, 21]-=-. To achieve this standardization, we analyzed a larger number of bioprosthetic valves that were removed because of suspected infective endocarditis or that were removed because of noninfective degene...

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...lvania State U niversity on A pril 8, 2016 http://cid.oxfordjournals.org/ D ow nloaded from Histological Examination of Bioprosthetic Heart Valves • CID 2006:42 (1 March) • 591 pathologic examination =-=[9]-=-. Pathologic examination of resected valve tissues remains the gold standard for the diagnosis of infective endocarditis, when these specimens are available [5]. Histological findings are included in ...

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...infiltrates are frequently seen in degenerative bioprosthetic valves removed for dysfunction (∼30% of the noninfective bioprostheses in our series) and may not be confused with infective endocarditis =-=[22]-=-. Some investigators distinguish acute inflammation (defined as the presence of neutrophilssat Pennsylvania State U niversity on A pril 8, 2016 http://cid.oxfordjournals.org/ D ow nloaded from Figure ...

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...ltrates in valve tissues. This defines “active endocarditis” in the Duke criteria; however, this histological concept has never been accurately defined at either the qualitative or quantitative level =-=[11]-=-. On the other hand, the mere presence of an inflammatory infiltrate in an excised cardiac valve is not sufficient for making the diagnosis of infective endocarditis, because inflammation is often obs...

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...d by physicians and surgeons at La Timone Hospital. Histological, immunohistochemical, and quantitative image analyses. Valve tissue samples were obtained according to a procedure described elsewhere =-=[12]-=-. Because resected valve tissue samples submitted to pathologic examination are often small in size, all entire valve tissue specimens were processed and paraffin-embedded. The valve tissue samples we...

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...theses can involve the cusps of bioprosthetic valves as well as biologic products, such as fibrin and organized thrombi, or the area of the suture material that connects the valve to the host tissues =-=[27]-=-, we observed that the infective process was mainly developed in the vegetations on the surface of the cusps. Adherent thrombi on the surface of bioprostheses may be one of the key events of the start...

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...f fibrin, platelets, and erythrocytes. Inflammatory cells usually are relatively few and consist mainly of macrophages and multinucleated giant cells, whereas T lymphocytes and neutrophils are scarce =-=[15]-=-. Most leukocytes remain confined to the surfaces, with little tendency to infiltrate the bioprosthetic tissue. Inflammatory infiltrates are frequently seen in degenerative bioprosthetic valves remove...

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... [15– 18]. Infection of implanted bioprostheses continues to be a major complication of cardiac valve replacement, and the casefatality rate remains high despite modern medical and surgical therapies =-=[1, 19, 20]-=-. The precise features that characterize histological infective endocarditis are not accurately standardized [4, 21]. To achieve this standardization, we analyzed a larger number of bioprosthetic valv...

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...s) as a histological feature highly suggestive of infection, from chronic inflammation, which is composed of inflammatory infiltrates with mainly mononuclear cells (i.e., macrophages and lymphocytes) =-=[11, 23]-=-. However, as we observed, neutrophils, macrophages, and T lymphocytes are often mixed in valvular inflammatory infiltrates. Moreover, a qualitative estimation of the different leukocyte subtypes by h...

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...valvular inflammatory infiltrates. The presence of vegetations and the visualization of microorganisms in valve tissue are well-known criteria for the histological diagnosis of infective endocarditis =-=[4, 11, 24]-=-. By use of quantitative analysis in this study, we have shown that vegetations, when present, represent an important part of valve tissue area (32.46% in average in our study). However, vegetations c...

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...and our colleagues showed with a study of Q fever endocarditis in bioprosthetic valves [25]. Finally, adherent thrombi can occur to the surface of bioprostheses as noninfective degenerative phenomena =-=[15, 26]-=-. These vegetation-like structures could be misdiagnosed as vegetations by echocardiography. In these cases, inflammatory infiltrates (if there are any) lining the vicinity of the bioprostheses are ma...