Lesions of the Coronary Arteries and Their Branches in Rheumatic Fever.

Karsner and Bayless' I very comprehensive analysis of the literature dealing with vascular disease occurring during the course of rheumatic fever has made it unnecessary to present a lengthy review of this subject. With the exception of the observations made by Bouillaud 2 3in i835 and I840, studies in this field were extremely vague until the latter part of the nineteenth century. This vagueness was due to the fact that the clinical and anatomical concepts concerning rheumatic fever were, for the most part, extremely ill-defined and that the scattered reports on vascular complications were generally based solely on clinical observations. In spite of Bouillaud's reports, half a century elapsed before Krehl 4 laid the basis for our modern concept of the relation of rheumatic fever to coronary artery disease. In this amazingly complete report entitled "Beitrag zur Pathologie der Herzklappenfehler" Krehl foreshadowed much of the important recent work on the interstitial, often perivascular, lesions now known as Aschoff bodies, predicted the important relation of these lesions to the clinical conception of heart failure in rheumatic fever, and made the further contribution that in this disease arteriosclerotic changes occur in the larger vessels, with thickenings, infiltrations and intimal proliferations in the walls of smaller vessels. The name of Romberg 5 must inevitably be linked with these earlier anatomical investigations on rheumatic fever. In 1894 this observer elaborated on Krehl's descriptions of coronary artery lesions, adding original observations on the occurrence of a diffuse hyaline thrombosis of the smaller arterioles and on the presence of a periarteritis involving a middle sized coronary artery. Since the beginning of the twentieth century many notable contributions have been made in this field, chiefly by Rabe,6 Aschoff,7 Barie,8 Aschoff and Tawara,9 Geipel,'0'11 Coombs,12 13, 14 Gerhardt,'TakIyasu,16 * Aided by a grant from the Lucus N. Littauer Foundation. Received for publication August 20, I934.