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April 13, 2021
Infective Endocarditis Lazare Riviere

Lazare Riviere (1589-1655)

Opera medica universa. Francofurti, J. P. Zubrodt, 1674

Lazare Riviere
Portrait of Lazare Riviere
Portrait of Lazare Riviere

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Lazare Riviere was a professor of Medicine at the University of Montpellier. He gave the earliest account of an aortic valve lesion consistent with endocarditis in 1646. This description appeared in his monumental work, "Opera medica universa,"  which was first published in 1674. A second edition of this book appeared in 1679.

Lazare Riviere described the case of a patient who presented with palpitation and irregular pulse. A few days later, he complained of dyspnea and swollen legs. On physical examination, Riviere noted that "when the hand was applied over the region of the heart, a most rapid, weak and irregular palpitation was felt."

The clinical situation of the patient progressively deteriorated and Riviere in his notes remarked:
"...the patient seemed in extremis, great suffocation seized him & there was no pulse in the arm and it could be perceived only with difficulty in the heart...the following night began to expel a black thick bloody sputum in balls with a troublesome cough...later the difficulty in respiration increased by day, the bloody sputum increased, and ...he died."

The postmortem examination showed:

"...the ventricle of the heart was found to be filled with a bloody mass and the whole lung was filled with much blood from which the suffocation of the natural spread to each part...Moreover in the left ventricle of the heart round carbuncles were found like the substance of the lungs, the larger of which resembled a cluster of hazelnuts & filled up the opening of the aorta, which I judged caused the failure of pulsations in the arteries. Now these carbuncles I thought were caused by the excessive blood which the marked heat of the ventricle hardened & in this manner changed its substance."

This description suggests that Riviere had some knowledge about the normal structure of the valves and that he was able to recognize these particular aortic lesions. It also indicates the influence of Galenic concepts in pathogenesis (heat generated in the left ventricle that would harden the valve structure) which were still predominant in the 17th century.

A word of caution is necessary about Riviere's account. Some historians have reported this observation as the first account of aortic valve stenosis whereas others have classified it as the first description of aortic valve endocarditis. Laennec in his treatise, "Mediate auscultation", gave credit to Riviere for providing the first account of aortic valve disease with vegetations compatible with aortic endocarditis.

The entire text of this observation is reproduced in the original Latin version (observation XXI).

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Major RH. Classic descriptions of disease. 3rd ed. Springfield Ill, CC Thomas,1945


Giovanni Morgagni