Pathogenesis of Endocarditis verrucosa simplex in the Newborn

Abstract

Verrucous endocarditis in the newborn is not only a rare but also a problematic disease as concerns its etiology and pathogenesis. In the older literature septic infections of mother and child were said to be the causative factors. Recent experiences with the pathophysiology and pathomorphology of shock have also shown new aspects of the origin of this kind of endocarditis.

Two cases from our own experience are compared with 7 cases from the literature. In the maternal history of gestation there was no infectious disease which could explain the endocarditis of the newborn. A short time after delivery the children showed a respiratory distress syndrome and died between 1.5 hours and 3 days after birth. At autopsy verrucous vegetations up to 8 × 5 × 4 mm in diameter were found on the tricuspid valve in 8 cases, once on the mitral valve and twice on both mitral and tricuspid valve. Malformations of the hearts were not noted. Histologically the fresh vegetations consist of clotted platelets and a fibrin network. At the base of the verruca the valvular leaflets show an edema, occasional fibroblastic changes and tiny lympho-histiocytic infiltrates in the subendothelial layer. Extracardial findings are hyaline membranes of the lungs and microthrombi in small vessels of lung, heart, liver and kidney due to shock and consumption-coagulopathy.

According to Mittermayer et al. (1971a, b) who studied endocarditis verrucosa simplex in adults and animal-experiments endocarditis verrucosa simplex of the newborn is probably caused by intrauterine or perinatal shock.

2 eigene Beobachtungen von Endocarditis verrucosa simplex bei Neugeborenen werden mit 7 Berichten aus der Literatur verglichen.

• 1.

  Die Endocarditis verrucosa simplex der Neugeborenen stellt kein eigenständiges Krankheitsbild dar, sondern ist Ausdruck eines Neugeborenenschocks und zumeist mit disseminierter, intravasaler Gerinnung und pulmonalen hyalinen Membranen verbunden.

• 2.

  Die Pathohistologie dieser Endokarditisform entspricht der Endocarditis verrucosa simplex Erwachsener.

• 3.

  Die ungewöhnliche Lokalisation der Endocarditis verrucosa simplex bei Neugeborenen auf der Valvula tricuspidalis könnte durch die besonderen Kreislaufverhältnisse der Fetal- und Neonatalperiode erklärt werden.

• 4.

  Klinische Daten und Schwangerschaftsanamnese schließen eine bakteriell septische Erkrankung als Ursache der Endocarditis verrucosa simplex aus.