02599nas a2200325   4500008004100000022004200041245006300083210006300146250001000209260000800219300001200227490000700239520164600246653001001892653000901902653002701911653001101938653001101949653000901960653001601969653002701985653005802012653003202070653001702102653006202119100001702181700001402198700001402212856004702226       1976                        eng d  a0040-6376 (Print) 0040-6376 (Linking)00aMiliary tuberculosis following homograft valve replacement0 aMiliary tuberculosis following homograft valve replacement  a27791  cFeb  a101 - 60 v313 aPostoperative septicaemia with infective endocarditis is a recognized complication of open-heart surgery, in particular homograft or prosthetic replacement of cardiac valves. Several infective organisms, both bacterial and fungal, have been incriminated but infection due to tubercle bacilli has not, to our knowledge, been reported. The clinicopathological features of this condition are discussed. During a five-year period, over 800 homograft replacements in the aortic and/or mitral positions have been performed at Harefield Hospital. Seven cases of miliary tuberculosis following homograft valve replacement are descrbied here. In three, there was a past history suggestive of tuberculosis infections but necropsy failed to reveal any caseous or other tuberculous lesion apart from recent miliary tuberculosis. Vegetations on the homograft valves contained microcolonies of acid-fast bacilli in most cases. Tubercle bacilli of the human type were recovered by culture or guinea-pig inoculation in six of the seven cases, and in three the diagnosis was established during life; two of these survived on antituberculosis chemotherapy. The onset of symptoms varied from a few weeks to 12 months after operation. The main presenting symptom was intermittent pyrexia. In two patients the diagnosis was made on radiological and clinical grounds and in both, tubercle bacilli were grown from drill biopsy specimens of lung tissue. The source of infection was presumed to be the homograft valves contaminated in the postmorten room. The antibiotic mixture used in the sterilization of the homografts was not effective against tubercle bacilli.10aAdult10aAged10aAortic Valve / surgery10aFemale10aHumans10aMale10aMiddle Aged10aMitral Valve / surgery10aMycobacterium tuberculosis / isolation & purification10aPostoperative Complications10aTime Factors10aTuberculosis, Miliary / diagnosis / *etiology / mortality1 aAnyanwu, C H1 aNassau, E1 aYacoub, M  uhttps://www.notifylibrary.org/reference/86