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Myofibroblastic proliferation on mitral valve chordae tendineae: a distinctive lesion associated with alcoholic liver
L C Stout1, P J Boor, E B Whorton
1Department of Pathology, University of Texas Medical Branch, Galveston 77550.
Insights
Distinctive bulbous thickenings (BTs) on mitral valve chordae tendineae were found in 4.3% of adult hearts. These acquired lesions show a strong correlation with alcoholic liver disease, particularly in males.
Area of Science:
- Cardiovascular Pathology
- Gastroenterology
- Histopathology
Background:
- Mitral valve chordae tendineae are crucial for heart function.
- Distinctive bulbous thickenings (BTs) are a rare finding in cardiac pathology.
- The etiology and associations of BTs are not well understood.
Purpose of the Study:
- To investigate the prevalence and histological characteristics of bulbous thickenings (BTs) on mitral valve chordae tendineae.
- To determine any potential associations between BTs and specific patient conditions, particularly liver disease.
Main Methods:
- Examination of 1,676 consecutive autopsies performed between 1980 and 1984.
- Histological analysis using light and electron microscopy of identified BTs.
- Statistical comparison of BT prevalence in patients with and without diagnosed liver disease.
Main Results:
- Bulbous thickenings (BTs) were identified in 4.3% of 1,083 adult hearts, absent in pediatric cases.
- Histology revealed BTs composed of myofibroblasts, collagen, and elastin, with no signs of inflammation.
- A statistically significant correlation (P < 0.01) was found between BTs and alcoholic hepatitis or cirrhosis (29.8% vs. 7.7%).
Conclusions:
- Bulbous thickenings (BTs) of the mitral valve chordae tendineae are acquired lesions.
- BTs are strongly associated with alcoholic liver disease.
- Further research may elucidate the specific mechanisms linking alcoholic liver disease and BT development.
Abstract:
Hearts from 1,676 consecutive autopsies were examined over a 4 1/2 year period between 1980 and 1984. Forty-seven (4.3%) of 1,083 adult hearts were found to have from one to nine distinctive bulbous thickenings (BTs) involving the mitral valve chordae tendineae. By light- and electron-microscopy, the BTs were found to consist of numerous myofibroblasts, collagen, and elastin layered over otherwise normal chordae and occasionally involving adjacent valve leaflets. No evidence of inflammation, rheumatic or otherwise, was found in histologic sections of the mitral, aortic, and tricuspid valves, or in samples of myocardium from all chambers. No BT was present in 593 hearts from infants and children, indicating that the lesions were acquired. Review of autopsy diagnoses showed that 14 (29.8%) of the 47 patients with BT had alcoholic hepatitis or micronodular cirrhosis, as opposed to 80 (7.7%) of the 1,036 patients without BT. This difference was highly statistically significant (P less than 0.01). The prevalence of viral liver disease was similar in the two groups. Of all patients with alcoholic liver disease, those with BT tended to be male and older. BT appears to be a distinctive process that is strongly correlated with alcoholic liver disease.
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