Pathology and etiology of 110 consecutively removed aortic valves.

OBJECTIVES: To study the pathology and determine the etiology and prevalence of aortic valve disease from surgically removed aortic valve specimens. MATERIAL AND METHOD: All the native surgically excised aortic valves (AV) received from June 1997 to March 1999 (22 months) were studied macroscopically including cuspal measurements and microscopically. By preoperative echocardiographic and macroscopic studies, they were classified into functional disorders of predominant aortic stenosis (AS), aortic stenosis with regurgitation (AS-AR) and predominant aortic regurgitation (AR). The patients' medical records were reviewed and the clinical information was extracted. The etiology was determined according to the macroscopic, microscopic and clinical findings. RESULTS: Among 110 AV (76 isolated AV and 34 with concomitant mitral valves from patients aged 15-96 years, mean age 47.54 years; male:female = 1.39:1) there were 25 AS (22.73%), 34 AS-AR (30.91%) and 51 AR (46.36%) cases. Eighty-four (76.36%) were tricuspid, 16 (14.54%) were bicuspid and 10 were undetermined. Cuspal measurements of each disease were provided and compared. All AS specimens were related to moderate to severe calcification and causes included postinflammatory disease (14 cases, 56%; age range 38-67 years, mean age 53.29 years, male:female = 0.56:1), degenerative calcific change (11 cases, 44%, age range 56-76 years, male:female = 1.2:1; mean age 69 years of 5 tricuspid AV and 60.83 years of 6 bicuspid AV). In AS-AR, 29 cases (85.29%; mean age 47.10 years; male:female = 1.23:1) were attributable to postinflammatory disease and 5 cases (mean age 70.20 years; male:female = 1.5:1) to degenerative calcific change. In pure AR, there were 21 cases (age range 15-65 years, mean age 29.76 years) of postinflammatory disease, 14 cases of infective endocarditis (IE) and postIE (age range 20-63 years, mean age 42.21 years; all 10 IE cases contained gram positive cocci), 1 case (age 55 years) of bicuspid calcific change, 8 cases of AV with dilated valve ring, 5 cases of miscellaneous causes and 2 cases of indeterminate etiology. Aschoff bodies were found in 3 AR cases. Four of 18 postinflammatory AS-AR and 4 of 14 postinflammatory disease AR cases had past history of rheumatic fever. One postinflammatory AS also had infective endocarditis from gram positive cocci without clinical sign. Severe degenerative calcific change had a higher incidence of underlying diabetes (3 of 15 cases, 20%), hypertension (8 of 14 cases, 57.14%) and dyslipoproteinemia (9 of 13 cases, 69.23%) in comparison with 3.37% (3/89) for diabetes, 9.09% (8/88) for hypertension and 30.99% (22/71) for dyslipoproteinemia in other AV diseases in combination. CONCLUSION: The three common causes of severe AV functional disorders were postinflammatory disease (58.18%), degenerative calcific change (15.45%) and IE-postIE (12.72%). Underlying diseases of severe degenerative calcific change included hypertension, dyslipoproteinemia and diabetes. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details are important in evaluating the etiology of valvular diseases especially in severely calcified specimens.

Pathology and etiology of 154 mitral valve abnormalities surgically removed in Siriraj Hospital.

Objectives: To study the pathology, determine the etiology and prevalence of mitral valve disease from surgically removed mitral valve specimens. Materials and Methods: All the native surgically excised mitral valves (MV) received during June 1997 to March 1999 (22 months) were studied macroscopically and microscopically. By preoperative echocardiographic and macroscopic studies, they were classified into functional disorders of predominant mitral stenosis (MS), mitral stenosis with regurgitation (MS-MR) and predominant mitral regurgitation (MR). The patients' medical records were reviewed and the clinical information was extracted. The etiology was determined according to the macroscopic, microscopic and clinical findings. Results: Among 154 MV (120 isolated MV and 34 with concomitant aortic valves from patients aged 7-79 years, mean age 43.98 years) there were 68 MS (44.16%), 30 MS-MR (19.48%) and 56 MR (36.36%) cases. All MS cases (age range 10 - 65 years, mean age 45.37 years, male : female = 1:1.51), all MS-MR cases (age range 20 - 66 years, mean age 40.03 years; male : female = 1:1.31) and 20 of 56 MR cases (35.71% of MR cases, 12.98% of total cases, age range 8 - 63 years, mean age 31.21 years, male : female = 1.22 : 1) were attributable to post-inflammatory disease. Prominent calcification occurred in 76.47% of MS, 70% of MS - MR and 25% of post-inflammatory disease MR cases. Moderate to marked neovascularization was found in 34.32% of MS, 56.66% of MS-MR and 65% of MR cases. Aschoff bodies were found in 1 MS and 4 MR cases. Eight of 39 MS (20.51%), 4 of 16 MS-MR (25%) and 6 of 13 (46.15%) post-inflammatory disease MR cases had past history of rheumatic fever. Other causes of pure MR included floppy valves (18 cases, 32.14% of MR cases, age range 40 - 79 years, mean age 61.72 years, male : female = 3.5 : 1;15 cases with chordal rupture), infective endocarditis (IE) [7 cases including one with post-inflammatory disease MS and one post-IE (age range 20 - 50 years, mean age 34.12 years, male : female = 6 : 1) with gram positive cocci in all IE], papillary muscle necrosis (1 case), ruptured necrotic papillary muscle (1 case), miscellaneous and indeterminate cause (4 cases). In comparison with post-inflammatory MR, posterior leaflet in floppy MR had longer basal-free edge length (mean basal-free edge length of floppy valve = 16.65 mm. p <.0001)and more frequent chordal rupture. Among MS and MS-MR post-inflammatory valves, 90.81% were completely excised whereas partial specimens were received in 40% of post-inflammatory MR, 61% of floppy valves and 50% of miscellaneous cases. Conclusion: Post-inflammatory disease (presumably rheumatic fever associated) of MV is still a main valvular heart disease in Thai patients undergoing valvular operation as it accounted for 75.97% of all MV specimens. In pure MR, the three most common causes were post-inflammatory disease, floppy valve and infective endocarditis. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details are important in the evaluation of the etiology of valvular disease especially in partial specimens.

Pulmonary leiomyoma in an HIV-infected child: A case report.

Smooth muscle tumors, benign or malignant, are rare in childhood. However, a higher incidence is found in HIV infected children with a reported association with Epstein-Barr Virus. We report a case of a 6-year-old HIV-infected girl who presented with a right upper lung mass and pulmonary tuberculosis. Histopathology of the resected mass showed a bronchiolar leiomyoma with adjacent noncaseous granulomas. Staining for AFB was negative. Polymerase chain reaction amplification for Mycobacterium tuberculosis complex was weakly positive. PCR amplification for EBV yielded a negative result.