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. 2013:2013:895215.
doi: 10.1155/2013/895215. Epub 2013 Feb 14.

Inflammatory Characteristics of Stenotic Aortic Valves: A Comparison between Rheumatic and Nonrheumatic Aortic Stenosis

Lars Wallby  1 , Thora Steffensen, Lena Jonasson, Mats Broqvist
Affiliations

Inflammatory Characteristics of Stenotic Aortic Valves: A Comparison between Rheumatic and Nonrheumatic Aortic Stenosis

Lars Wallby et al. Cardiol Res Pract. 2013.

Abstract

Background. Although our comprehension of nonrheumatic aortic stenosis (NRAS) has increased substantially during the last decade, less is known about the histopathology of rheumatic aortic stenosis (RAS). The aim of this study was to investigate rheumatic aortic stenosis by means of analyses previously used in nonrheumatic stenosis. Material and Methods. Valve specimens were obtained from 39 patients referred to hospital due to significant aortic stenosis. According to established macroscopic criteria the valves were divided into two groups consisting of 29 NRAS and 10 RAS valves. Mononuclear inflammatory cells and apolipoproteins were investigated using immunohistochemical analyses. Results. The localisation of calcification differed in tricuspid nonrheumatic valves when compared to bicuspid nonrheumatic and rheumatic valves. The RAS valves revealed a lower degree of T lymphocyte infiltration compared with the NRAS valves. Infiltration of macrophages was seen in all valves and there were no differences regarding deposition of apolipoprotein. Conclusion. Rheumatic and nonrheumatic aortic stenotic valves show a similar and significant chronic inflammation. The similarities regarding the localisation of calcification indicate that the valve anomaly/morphology can influence the pathogenesis of aortic stenosis. Finally, our findings highlight the question of a postinflammatory valvular disease of other causes than rheumatic fever.

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Figures

Figure 1
Figure 1
(a) Destruction of architecture in RAS as compared to NRAS; data given as percent (%) of (n). (b) Degree of neovascularisation in RAS as compared to NRAS, <1/3 = in the basal third of valve cusp, >1/3 = beyond basal third of valve cusp; data given as percent (%) of (n). RAS = rheumatic aortic stenosis, NRAS = nonrheumatic aortic stenosis.
Figure 2
Figure 2
Localisation of calcification; number of valves given as percent (%) of (n). RAS = rheumatic aortic stenosis, NRAS = non rheumatic aortic stenosis.
Figure 3
Figure 3
(a) Degree of lymphocyte infiltration in RAS as compared to NRAS. Number of valves given as percent (%) of (n). (b) Degree of macrophage infiltration in RAS as compared to NRAS. Number of valves given as percent (%) of (n). RAS = rheumatic aortic stenosis, NRAS = nonrheumatic aortic stenosis.
Figure 4
Figure 4
Degree of apolipoprotein B and A-1 deposition in RAS as compared to NRAS valves, data given as number of valves in percent (%) of (n). RAS = rheumatic aortic stenosis, NRAS = nonrheumatic stenosis.
See this image and copyright information in PMC

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