Patterns of infective endocarditis as seen at autopsy during a five year interval, 1965 through 1969, were reviewed. The frequency of infective endocarditis was relatively high (forty-seven of 1,881 patients, 2.5 per cent). Failure of clinical recognition of infective endocarditis in 43 per cent of the forty-seven patients is a major factor in the relatively high mortality of this disease. In sixteen of the forty-seven patients (34 per cent) a prosthetic heart valve was present. Seven of these sixteen had active infective endocarditis on a prosthesis which had not been inserted specifically for the treatment of infective endocarditis. All seven patients were receiving usual antibiotic therapy and represent antibiotic treatment failures. In the remaining nine patients, the prosthetic valves had been inserted to correct hemodynamic sequelae secondary to valve deformity following antibiotic therapy of infective endocarditis. In these nine patients, the infection was inactive at the time of autopsy. Valve perforations were present or had been surgically corrected in twenty-two of the forty-seven patients (47 per cent). Intractable congestive heart failure was the cause of death in only 8.5 per cent of our series. Thus in our experience infection has replaced congestive heart failure as the most frequent cause of death.
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