Pathology of Valvular Diseases Flashcards
Acquired valvular diseases:
3 main pathologic changes in the valves
Nodular calcification
Collagen damage
Fibrotic thickening
Nodular calcification
Calcific aortic stenosis
Calcific stenosis of congenitally bicuspid aortic valve
Mitral annular calcification
Where does mitral annular calcification usually develop?
Develops in the fibrous annulus
Example of damage to collagen
MVP: Mitral valve prolapse
Mitral valve prolapse
Gross morphology
Mitral leaflets?
Tendinous cords?
Interchordal ballooning (hooding) of mitral leaflets
Affected leaflet - enlarged, thick, redundant, rubbery
Associated tendinous cords - elongated, thinned, ruptured
Mitral valve prolapse
Microscopic morphology: __________ degeneration
Myxomatous degeneration
Spongia layer thickening
Deposition of mucoid (myxomatous) material
Attenuation of collagenous fibrosa
Examples of fibrotic thickening
Rheumatic fever and rheumatic heart disease
Acute rheumatic carditis
Chronic rheumatic heart disease
What is pancarditis?
Inflammation may be found in all layers (endocarditis, myocarditis, pericarditis)
Myocarditis
Aschoff bodies
Anitschkow cells
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
Endocarditis
Involves what parts?
Fibrinoid…
Involves endocardium and left-sided valves
Cardinal anatomic changes in CRHD
Leaflet thickening, looks nodular, might calcify
Commissural fusion and shortening (CHRD vs mitral annular calcification)
Tendinous cords thickening and fusion
Infective endcarditis
Microbial infection of heart valves or mural endocardium, leading to vegetation
Acute vs Subacute infective endocarditis
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)
Nonbacterial thrombotic endocarditis
Deposition of small, sterile, non-infectious thrombi on the leaflets of valves
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 ______
Calcific aortic stenosis
deposition of HYDROXYAPATITE –> mineralization of valve
begins at the outflow surface, side facing the aorta