Hi
Ryanvs;n869689 said:
Ive tried to do some research online, but I haven't found the answer so maybe some here can explain something to me.
I expect that why you aren't finding much on line is because noone has done any definitive research. I expect the reasons for this are many fold, like: noone is paying for it, noone of sufficient interest and ability has time (because someone is paying them for something else) no one feels that it is knowledge that brings much with it (such as prevention), it doesn't effect many people ...
So with that in mind what follows is my conjecture (which by the way I've passed by a few people who are smarter / more specifically educated / older than me.
Basically your blood vessels (and your heart) are lined with a layer of cells called
endothelia. These cells essentially make the surface of your tubes rather non stick (among other functions) like a non-stick pan, so as you can imagine cutting through the aorta to replace the valve causes disruption just like any scar you may get on your skin. This alters the smooth surface (think dolphin skin) that is beautifully designed to be hydraulically smooth too, to being rough and may have surface irregularities or lumps. Tto go with that earlier metaphor making a place on the pan where stuff sticks more easily.
Certainly endothelia grow back (even on the inside of the dacron graft in an aneurysm repair) but now the surface is poc marked and irregular which makes it much easier for bacteria to lodge and grow.
Now the endothelia don't have a role in the destruction of bacteria, only in the first level of protection, its the white blood cells that have that role. It could be that the damage to the endothelia is a bit trench or crater like (at a microscopic level) and that allows the bacteria to grow in a 'vegetative" manner and prevents the white blood cells from entirely defeating them.
Many bacteria are called opportunistic and so when the body is busy fighting one thing the other has a chance to grow.
This is why not only valve replacement patients (and to my knowledge there is no difference discovered in tissue VS mechanical prosthesis for rates of endo) but also people who have had diseases (like scarlet fever) may have their endothelia in their heart damaged and even their valve tissue surfaces scarred leading to them also being more likely to get endo than the general population.
The stress on oral hygene (which is often stressed but no actual education on how to attain that is given) is correct because in the general population mouths are festeringly filthy places. If ever you've had to take a step back from someone with rancid rotting breath that's because their mouth is thousands of times more infested than normal. The society at large knows nothing about bacteria and mis-interprets bad breath or bleeding gums as something unique to them (like their height or their hair colour) and something which can be covered up. It is in fact a clue to how infested your mouth is with growing things.
Thus its good to sit down and talk openly with your oral hygienist about how to floss properly and how to keep your mouth from becoming a bacterial playground. gingivitis in a mild form can be mistaken by a person (not a dentist) for "sensitive gums" ... its actually an indicator of plaque build up which is essentially the "coral reef on your tooth" that bacteria build up to live in , just like the marine coral polyps do on rocks.
I hope that helps.
