Pathology of Valvular Diseases Flashcards

1
Q

Acquired valvular diseases:

3 main pathologic changes in the valves

A

Nodular calcification
Collagen damage
Fibrotic thickening

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2
Q

Nodular calcification

A

Calcific aortic stenosis

Calcific stenosis of congenitally bicuspid aortic valve

Mitral annular calcification

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3
Q

Where does mitral annular calcification usually develop?

A

Develops in the fibrous annulus

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4
Q

Example of damage to collagen

A

MVP: Mitral valve prolapse

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5
Q

Mitral valve prolapse

Gross morphology
Mitral leaflets?
Tendinous cords?

A

Interchordal ballooning (hooding) of mitral leaflets

Affected leaflet - enlarged, thick, redundant, rubbery

Associated tendinous cords - elongated, thinned, ruptured

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6
Q

Mitral valve prolapse

Microscopic morphology: __________ degeneration

A

Myxomatous degeneration

Spongia layer thickening
Deposition of mucoid (myxomatous) material
Attenuation of collagenous fibrosa

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7
Q

Examples of fibrotic thickening

A

Rheumatic fever and rheumatic heart disease
Acute rheumatic carditis
Chronic rheumatic heart disease

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8
Q

What is pancarditis?

A

Inflammation may be found in all layers (endocarditis, myocarditis, pericarditis)

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9
Q

Myocarditis

Aschoff bodies
Anitschkow cells

A

Aschoff bodies – nodules
Anitschkow cells – pathognomonic for rheumatic fever – t lymphocytes, plasma cells, plump activated macrophages

Assoc with fibrinoid necrosis within the nodule

Can cause cardiac dilation –> functional MV insufficiency

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10
Q

Endocarditis

Involves what parts?
Fibrinoid…

A

Involves endocardium and left-sided valves

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11
Q

Cardinal anatomic changes in CRHD

A

Leaflet thickening, looks nodular, might calcify

Commissural fusion and shortening (CHRD vs mitral annular calcification)

Tendinous cords thickening and fusion

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12
Q

Infective endcarditis

A

Microbial infection of heart valves or mural endocardium, leading to vegetation

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13
Q

Acute vs Subacute infective endocarditis

A

Acute IE - infection of a healthy valve by a highly virulent organism (S. aureus, Strep pyogenes)

Subacute IE - insidious infection of structurally abnormal valve by a lower virulent organism (S. viridans, S. epidermidis)

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14
Q

Nonbacterial thrombotic endocarditis

A

Deposition of small, sterile, non-infectious thrombi on the leaflets of valves

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15
Q

Most common of all valve abnormalities
Age-associated wear and tear

What is its disease process – deposition of _______, begins at the outflow surface, i.e. side facing the ______

A

Calcific aortic stenosis

deposition of HYDROXYAPATITE –> mineralization of valve
begins at the outflow surface, side facing the aorta

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16
Q

Calcific aortic stenosis:
Gross and Microscopic morphologic hallmarks

Gross:

  • calcified nodules w/n aortic cusps
  • protrude thru _____ into ______
  • _________ not involved
  • !!!________ fusion not seen!!!

Microscopic:

  • layered architecture: ?
  • ECM: ?
  • calcific process begins at the _______ layer
  • cells w/n ECM resemble ___________ (what may be produced w/n the valve?)
  • ___________ variable
A

Gross:

  • calcified nodules w/n aortic cusps
  • protrude thru outflow surfaces into sinuses of valsalva (aortic sinuses)
  • free edges not involved
  • !!!commissural fusion not seen!!!

Microscopic:

  • layered architecture preserved
  • calcified/mineralized ECM
  • calcific process begins at the valvular fibrosa layer
  • cells w/n ECM resemble osteoblasts (metaplstic bone may be produced w/n the valve)
  • inflammation variable
17
Q

Calcific aortic stenosis:
Gross morphologic hallmarks

Gross:

  • calcified nodules w/n aortic cusps
  • protrude thru _____ into ______
  • _________ not involved
  • !!!________ fusion not seen!!!
A

Gross:

  • calcified nodules w/n aortic cusps
  • protrude thru outflow surfaces into sinuses of valsalva (aortic sinuses)
  • free edges not involved
  • !!!commissural fusion not seen!!!
18
Q

Calcific aortic stenosis:
Microscopic morphologic hallmarks

Microscopic:

  • layered architecture: ?
  • ECM: ?
  • calcific process begins at the _______ layer
  • cells w/n ECM resemble ___________ (what may be produced w/n the valve?)
  • ___________ variable
A

Microscopic:

  • layered architecture preserved
  • calcified/mineralized ECM
  • calcific process begins at the valvular fibrosa layer
  • cells w/n ECM resemble osteoblasts (metaplstic bone may be produced w/n the valve)
  • inflammation variable
19
Q

Having a calcific stenosis of congenitally bicuspid aortic valve predisposes one to other cardiac conditions such as… (give 3)

A

Aortic dilation and dissection
IE - infective endocarditis
Aortic insufficiency

20
Q

Mitral annular calcification typically develops in the ________

A

Mitral annular calcification typically develops in the FIBROUS ANNULUS

21
Q

Mitral annular calcification does not usually affect valvular function, except in cases where it leads to ________, _________, __________

A

Regurgitation
Stenosis
Arrhythmias and occasionally sudden death

22
Q

How would you characterize the calcific deposits in mitral annular calcification?

A

Degenerative

23
Q

Mitral annular calcification:
Gross and Microscopic morphologic hallmarks

Gross: describe the nodules formed

Microscopic:

  • layered architecture: ?
  • ECM: ?
  • calcific process begins at the _______ layer
  • cells w/n ECM resemble ___________ (what may be produced w/n the valve?)
  • ___________ variable
A

Gross:

  • !!!irregular, stony hard, occasionally ulcerated nodules!!!
  • base of leaflets
  • protrude thru outflow surfaces
  • free edges not involved
  • commissural fissures not seen

Microscopic:
-similar to calcific aortic stenosis

i. e.
- layered architecture preserved
- calcified/mineralized ECM
- calcific process begins at the valvular fibrosa layer
- cells w/n ECM resemble osteoblasts (metaplstic bone may be produced w/n the valve)
- inflammation variable

24
Q

Mitral annular calcification: Complications

  • Nodules as site of _____
  • Nidus for _____
A
  • Nodules as site of thrombus formation

- Nidus for IE