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May 5, 2021
Infective Endocarditis Jean Nicolas Corvisart des Marest

Jean-Nicolas Corvisart (1755-1821)

Essai sur les maladies et les lesions organiques du coeur et des gros vaisseaux. Paris, Mequignon- Marvis, 1806

Jean Nicolas Corvisart des Marest
Portrait of Jean Nicolas Corvisart des Marest
Portrait of Jean Nicolas Corvisart des Marest

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As previuosly discussed, Riviere, Lancisi, Vieussans, and Morgagni were among the first authors to describe lesions of the aortic valve compatible with infective endocarditis. Jean-Nicolas Corvisart was the physician who gave the earliest account of infective lesions of the mitral valve.

Jean-Nicolas Corvisart was one of the most outstanding physicians of the first half of the 19th century. He published his monograph, "Essai sur les maladies et les lesions organiques du coeur et des gros vaisseaux," which included several original descriptions in 1806. Corvisart contributed extensively to the knowledge of the heart diseases and his work influenced generations of physicians across Europe.

Throughout his career, Corvisart was a great advocate of clinical and postmortem examinations and clinico-pathological correlation.

In his monograph, Corvisart described very carefully indurations and calcifications of the cardiac valves. He was the first to distinguish two types of valvular lesions and introduced the term "vegetation". This new term was referring to soft excrescences on cardiac valves. In his accounts, He made a clear distinction between valvular indurations and calcifications (osseous asperities) which were very hard and consistent lesions and vegetations which were described as soft lesions which could be easily detached from the surface area of valve leaflets.

He described the similarity of these vegetations to that of venereal warts and suggested that they might be from syphilitic origin. He also mentioned that these vegetations can be very large, thus obstructing the orifice of the valves and compromising the blood circulatiion.

In his monograph, Corvisart wrote that he had observed six cases of valve disease with vegetations.

The observation XXXVII is of great interest. Corvisart reported the case of a 39 year-old male with a history of rheumatic arthralgia at the age of twenty. He presented with, fever, coughe, abdominal pain, episodes of vomiting, and lower extremities edema. At physical examination, he noted an enlargerd liver, but did not feel any palpable thrill at the precordial region. The patient's clinical situation worsened very rapidly and he died from heart failure. At autopsy, Corvisart noted the presence of vegetations at the free margin of the mitral anterior leaflet with several chordae rupture. He also noted small vegetations on the aortic valve.

The following short quotation is from the English version of Corvisart's monograph :

"On dissection...The large portion of the mitral valve, which lies before the orifice of the aorta, held no longer by the tendinous threads to the columnae carneae in which these filaments terminated. At its edge, become loose, many species of very irregular and long vegetations were appended, imitating certain venereal excrescences..."

The observation XXXVIII described the case of a 23-year-old female with a history of "inflammatory disease of the chest" at the age of fifteen. This patient presented with fever, dyspnea, palpitation, and anxiety. Additional clinical symptoms were epistaxis and episodes of vomiting. Her pulse was irregular at physical examination. She died after a few days of hospitalization. Postmortem examination showed a "narrowed mitral valve" with cartilaginous transformation and the presence of multiple vegetations in all four cardiac valves.  Here, obviously Corvisart described a case of rheumatic valve disease complicated with infective endocarditis.

The entire chapter of Corvisart's monograph on valvular vegetations is displayed here.

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Giovanni Morgagni Joseph Hodgson