948 
ANIMAL DISEASES 
f COXSACKIEVIRUS B4 VALVULITIS 
* (Mifral Valve) 
CYNOMOLGUS MONKEY 0^ 
Monkey f^6 
178 Days after I. V. Inoculation 
■' ',V S'-''- ''■-•t:', ' -y^^ ■ 
Figure 5. — Photomicrograph of mitral valve lesion 
shown in Figure 3, displaying round cell infiltration, 
fibroblastic proliferation and stromal edema (Am. 
Heart J. 71:678, 1966). 
myocardium of virus-inoculated animals. Addi- 
tional studies in this laboratory have demon- 
strated that Anitschkov^f's myocytes and 
Aschoff-like bodies may be identified in damaged 
tissue from cynomolgus monkeys inoculated 
with coxsackievirus 64^°. 
The experimental animal has proven to be an 
excellent model for testing the hypothesis that 
viral disease may be associated v^^ith acute and 
chronic valvular disease. It remains to be dem- 
onstrated that viral disease produces valvulitis 
in man. However, it is of interest that group B 
coxsackievirus antigens were identified by im- 
munofluorescent technics in the myocardium of 
17 and in the mitral valve of 3 of 55 patients at 
routine autopsy.^^ 
There is a need for further study of the role 
of viruses in the pathogenesis of valvular dis- 
ease in the human population. We can no longer 
accept the diagnosis of rheumatic valvulitis in 
the absence of a history of rheumatic fever 
without considering other etiologic possibilities. 
SUMMARY 
Although viruses are well known to produce 
pericarditis and myocarditis, they have not 
been recognized as a cause of acute and chronic 
valvulitis. 
To test the hypothesis that viruses may pro- 
duce endocarditis, over 200 mice and 7 cynomol- 
gus monkeys were inoculated with coxsackie- 
virus B4. Mural endocarditis was found in 50% 
and valvulitis in 55% of the virus-inoculated 
mice. Valvulitis was found in 6 of the 7 virus- 
inoculated monkeys. In some instances the val- 
cular lesions were strikingly similar to those of 
chronic rheumatic valvulitis in man. 
It is suggested that viruses may play a role in 
the pathogenesis of human valvular disease and 
that it is no longer reasonable to assume that 
chronic valvular disease in the absence of an an- 
tecedent history of rheumatic carditis is always 
due to occult or subclinical rheumatic fever. 
REFERENCES 
1. BuRCH, G. E., DePasquale, N. P., Sun, S. C, 
MOGBGAB, W. J., and Hale, A. R. Endocarditis in 
COXSACKIEVIRUS B4 VALVULITIS 
(Mitral Valve) 
CYNOMOLGUS MONKEY 
200 Days after I. V. Inoculation Monkey #9 
Figure 6. — Photomicrograph of the mitral valve lesion 
shown in Figure 4, displajnng round cell infiltration, 
stromal edema, and thickening of the chordae tendi- 
neae (Am. Heart J. 71:678, 1966). 
