5. Separations Of Continuity

Separations of continuity occur under the forms of laceration of varying depth at any part of the valve, from the margin towards its insertion - as perforation of the valve at different parts more or less remote from the margin - and as a loosening of the valve at the margin of its insertion; and affect the auriculo-ventricular as well as the arterial valves. Commonly only one or other of these forms occurs; occasionally, however, several are present either in one or more of the valves. One very important form of lo?sio continui, which does not affect the valve throughout its whole thickness, but only one of the layers of endocardium and a certain portion of its fibrous tissue, is especially worthy of notice, since it constitutes the basis of aneurism of the valves, to which we shall refer more fully in the sequel.

These lacerations of the valves are occasioned by disease of the valvular tissues, arising chiefly from their gelatinous condition; next in frequency, by inflammation (endocarditis); and, lastly, by the loosening of the tissue which accompanies inflammation of the valves. Lacerations of the valves are not only highly important, from the circumstance that their existence presupposes a high degree of the diseases we have already named, but also from their giving rise to valvular insufficiency.

6. Diseases Of Texture

To these belong: a. Inflammation (endocarditis) of the valves, which is by far the most frequently observed. This disease is especially important from its results, that is to say, from the morbid changes of the valves to which it gives rise, and the various heart-diseases depending upon the latter alterations.

Endocarditis, as we have already observed, especially affects the valvular system, which in many cases is alone diseased, while in others, it participates in the endocarditis attacking other parts. The valves of the left side of the heart are especially subject to this disease, as we have already seen; and even where the valves on both sides are diseased, those on the right side are always affected in a very much less intense degree.

Inflammation of the valves, in very many cases, is limited to the free margin, whilst, in others, it extends from thence to a various extent towards the insertion of the valve, and not unfrequently attacks the insertion itself, extending to the endocardium of the cavities of the heart and to the tendons of the papillary muscles.

In addition to what has been stated in reference to endocarditis, the following short notice may suffice to explain the characteristics of this disease.

1. Redness And Injection

Vascularity of the Fibrous Tissue of the Valves - can only be observed in rare cases of recent endocarditis, for this condition has generally passed into exudation, and cannot be recognized in consequence of the products deposited in the tissue of the valve. Considerable difficulty, moreover, attends the discovery of vascularity, even in recent cases, since it is most frequently masked by the redness of the valves occasioned by imbibition.

2. Opacity And Bulging

Opacity And Bulging of the Valve are among the most prominent appearances, and depend upon the deposition of inflammatory products in the tissue of the valve. They attain considerable intensity, and are either limited to the free margin of the valve, or extend over a greater portion of it; in some cases the whole valve with its attached margin, or in others with the papillary tendon, is implicated. The endocardium of the valve at several spots loses its usual smoothness and lustre, and the whole has a rough pilous appearance.

3. Loosening Of The Tissue Of The Valve

There may be Loosening of the Tissue of the Valve, which, in intense inflammation, predisposes to laceration.

4. An Inflammatory Product

An Inflammatory Product, which, in addition to the exudation infiltrated into the tissue of the valve and effused and solidified upon its free surface, appears in recent cases as a pilous and granular coagulum in the form of vegetations, or as a membranous exudation having a free finely villous surface, beneath which the valve appears rough, felt-like, and excoriated. In cases of long standing, these products may often be more readily recognized in the form of a more or less stratified pseudo-membrane, on which depend the thickening and the various forms of adhesions and coalescence of the valves.