Pathology of Valvular Diseases Flashcards
(24 cards)
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
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
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
Calcific aortic stenosis:
Gross morphologic hallmarks
Gross:
- calcified nodules w/n aortic cusps
- protrude thru _____ into ______
- _________ not involved
- !!!________ fusion not seen!!!
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!!!
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
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
Having a calcific stenosis of congenitally bicuspid aortic valve predisposes one to other cardiac conditions such as… (give 3)
Aortic dilation and dissection
IE - infective endocarditis
Aortic insufficiency
Mitral annular calcification typically develops in the ________
Mitral annular calcification typically develops in the FIBROUS ANNULUS
Mitral annular calcification does not usually affect valvular function, except in cases where it leads to ________, _________, __________
Regurgitation
Stenosis
Arrhythmias and occasionally sudden death
How would you characterize the calcific deposits in mitral annular calcification?
Degenerative
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
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
Mitral annular calcification: Complications
- Nodules as site of _____
- Nidus for _____
- Nodules as site of thrombus formation
- Nidus for IE
