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[Biopsy of the heart valves. 872 cases]
Insights
Pathological examination of 872 heart valves revealed calcific aortic stenosis as the most common disease. Mitral stenosis, a post-rheumatic condition, was also frequent, with changing demographics suggesting future increases in aortic valve disease.
Area of Science:
- Cardiovascular Pathology
- Surgical Pathology
Context:
- Analysis of 872 surgically excised heart valves from 810 patients over 5 years (1994-1998).
- Predominance of aortic valves (506) over mitral valves (246).
- Sex distribution varied between valve types: aortic valves more common in men, mitral valves in women.
Purpose:
- To pathologically examine surgically excised heart valves and identify prevalent valvular diseases.
- To analyze the etiological and demographic patterns of heart valve diseases.
Summary:
- Isolated calcific aortic stenosis (418 pts), particularly the sclerotic-senile type (238 pts), was the most frequent diagnosis.
- Mitral stenosis (185 pts) was identified as a classical post-rheumatic disease.
- Other conditions included pure aortic and mitral incompetence due to myxoid degeneration, combined aorto-mitral disease, and lesions related to infective endocarditis.
Impact:
- Highlights the prevalence of calcific aortic stenosis and post-rheumatic mitral stenosis.
- Suggests a future shift towards increased aortic valve disease, especially degenerative types, due to an aging population and declining rheumatic fever.
- Provides insights into the etiology and demographic trends of heart valve pathologies, informing clinical expectations and research directions.
Abstract:
In this study, 872 heart valves surgically excised from 810 patients during a period of 5 years (1994 through 1998) were examined pathologically. There was a predominance of aortic (506 patients) versus mitral valves (246 pts.). While aortic valves came more often from men (364) than from women (142), in mitral valves the M:F ratio is 82/164. Isolated calcific aortic stenosis appeared as the most frequent valvular disease (418 pts.), with predominance of its sclerotic-senile type (238 pts.). Mitral stenosis (185 pts.) remains the classical post-rheumatic disease. The relative frequency of a subvalvular stenosing mitral lesion is stressed. The "pure" incompetence of both aortic (70 pts.) and mitral (56 pts.) valve was usually based on valvular myxoid degeneration. An aorto-mitral disease requiring replacement of both valves (51 pts.) presented typically as a post-rheumatic lesion, however, a combination of a post-rheumatic mitral with a degenerative-sclerotic aortic valve disease may be possible. In 30 patients, the valvular replacement was performed for infective endocarditis or a post-IE lesion, mostly of the aortic valve. With the almost non-existence of acute rheumatic fever and with the increasing average age of population in this country, we may expect a long-term decline in mitral valve disease and an increase in aortic valve disease, particularly in the sclerotic type of aortic stenosis.