[Cardiac lesions in bacterial endocarditis: from findings of pathology to possibilities and limits of surgery].

Infective endocarditis remains a common condition for pathologists interested in cardiology who fortunately examine more infected valves excised surgically (66 in 1992) than observed at autopsy after death from this condition (2 in 1992). The authors discuss the elementary valvular lesions (ulceration and vegetations), the severity of which affects the prognosis, and the special aspects of these ulcerating vegetations with respect to their location (aortic, mitral, pulmonary and tricuspid), to the type of underlying valvular disease (rheumatic, myxoid or calcific) and infecting organism. The extravalvular complications are then reviewed: annular abscess (and possible extensions), purulent pericarditis, parietal endocarditis, myocarditis and coronary embolism. The authors attempt to answer questions about infective endocarditis from the pathologist's viewpoint: the difference between acute and subacute endocarditis, the reality of infective lesions of "healthy hearts", the role of the pathologist in the detection of pathogenic organisms, the evolution of lesions after sterilisation. The particular situation of prosthetic valve (biological or mechanical) endocarditis is treated in detail. The role and possibilities of surgery, the value of which is now universally accepted (the mortality of severe infective endocarditis has been lowered from 50-60% to 10-20% by a good operative strategy) are emphasised throughout.