Correlation between clinical and postmortem findings in cases with valve replacement

ABSTRACT

Thirty patients who died after cardiopulmonary bypass for valve replacement were pathologically examined. Four major causes of death were encountered on postmortem examination, including congestive heart failure [43.4%], infective endocarditis [33.3%], prosthetic complications [16.7%] and bleeding [6.7%]. The time of death after operation varied from 2 weeks to 2.5 years according to myocardial condition and period of preservation during operation. All cases had cardiomegaly and brown induration of the lungs. Patients who died from congestive heart failure had chronic venous congestion of the liver 11 cases [84.6%], spleen 9 cases [69.2%] and kidneys in 6 cases [46.1%]. Splenomegaly and large vegetations [1.3-3 cm] were found in all patients who died from infective endocarditis. Other complications seen in patients who had infective endocarditis included pulmonary infarction [10%], focal glomerulonephritis [33.3%], proliferative glomerulonephritis [10%] and cerebral hemorrhage [20%]. It is important to emphasize that surgery for rheumatic valvular affection should be performed at an early stage before irreversible myocardial damage occurs in order to avoid a high mortality rate