TY - JOUR
T1 - Intraleaflet hemorrhages are a common finding in symptomatic aortic and mitral valves
AU - Stam, Olga C. G.
AU - Daemen, Mat J. A. P.
AU - van Rijswijk, Jan Willem
AU - de Mol, Bas A. J. M.
AU - van der Wal, Allard C.
PY - 2017
Y1 - 2017
N2 - Introduction: Intraleaflet hemorrhage (ILH) has been reported to occur in calcified degenerated aortic valves. At present, no such information is available for mitral valves or for other types of valvular disease. We examined the prevalence, age, and potential source of ILH in a consecutive series of surgically removed aortic and mitral valves, and related the findings to specific types of heart valve pathology. Methods: A total of 105 aortic (n=85) and mitral (n=20) valves were retrieved from 100 symptomatic patients. Pathological diagnosis was made on photographic images and histology. Presence, extent, and age of ILH; its possible association with calcification; microvessels; and microvascular leakage were assessed with conventional and immunohistochemical staining methods and related to the type of underlying valvular disease. Results: Pathological diagnosis revealed degenerative aortic valve disease (n=70), postinflammatory disease (n=16), endocarditis (n=12), myxoid degenerative mitral valve disease (n=6), and one normal valve. ILH was found in 86% of aortic and 75% ofmitral valves. Microvessels were present in 91% of all valves. Microvascular leakagewas noted in 70% of aortic and 84% of mitral valves; in both groups, colocalization with ILH was found in 48%. Most aortic valves (91%) contained calciumdeposits, of which 54% showed colocalization with ILH. In 66% of valves with ILH, a combination of recent hemorrhage and iron deposits was seen, indicating an ongoing process of episodic hemorrhages. Conclusion: The prevalence of ILH is very high in resected heart valves. Both aortic and mitral valves showed an association of ILH with microvessels, microvascular leakage, and calcifications. We speculate that repetitive microvascular-leakage-related ILH may contribute to valve dysfunction on the (very) long term. (C) 2017 The Authors. Published by Elsevier Inc
AB - Introduction: Intraleaflet hemorrhage (ILH) has been reported to occur in calcified degenerated aortic valves. At present, no such information is available for mitral valves or for other types of valvular disease. We examined the prevalence, age, and potential source of ILH in a consecutive series of surgically removed aortic and mitral valves, and related the findings to specific types of heart valve pathology. Methods: A total of 105 aortic (n=85) and mitral (n=20) valves were retrieved from 100 symptomatic patients. Pathological diagnosis was made on photographic images and histology. Presence, extent, and age of ILH; its possible association with calcification; microvessels; and microvascular leakage were assessed with conventional and immunohistochemical staining methods and related to the type of underlying valvular disease. Results: Pathological diagnosis revealed degenerative aortic valve disease (n=70), postinflammatory disease (n=16), endocarditis (n=12), myxoid degenerative mitral valve disease (n=6), and one normal valve. ILH was found in 86% of aortic and 75% ofmitral valves. Microvessels were present in 91% of all valves. Microvascular leakagewas noted in 70% of aortic and 84% of mitral valves; in both groups, colocalization with ILH was found in 48%. Most aortic valves (91%) contained calciumdeposits, of which 54% showed colocalization with ILH. In 66% of valves with ILH, a combination of recent hemorrhage and iron deposits was seen, indicating an ongoing process of episodic hemorrhages. Conclusion: The prevalence of ILH is very high in resected heart valves. Both aortic and mitral valves showed an association of ILH with microvessels, microvascular leakage, and calcifications. We speculate that repetitive microvascular-leakage-related ILH may contribute to valve dysfunction on the (very) long term. (C) 2017 The Authors. Published by Elsevier Inc
U2 - https://doi.org/10.1016/j.carpath.2017.06.002
DO - https://doi.org/10.1016/j.carpath.2017.06.002
M3 - Article
C2 - 28666146
SN - 1054-8807
VL - 30
SP - 12
EP - 18
JO - Cardiovascular pathology
JF - Cardiovascular pathology
ER -