Active valvulitis associated with chronic rheumatic valvular disease and active myocarditis

Area of Science:

• Cardiology
• Rheumatology
• Pathology

Background:

• Chronic rheumatic valvular disease is a significant cause of cardiac morbidity.
• Active rheumatic myocarditis, characterized by Aschoff bodies, is a key pathological feature.
• Understanding the inflammatory process in valvular disease is crucial for management.

Purpose of the Study:

• To evaluate the incidence, distribution, and severity of active inflammation in heart valves of patients with chronic rheumatic valvular disease.
• To correlate histological findings with clinical evidence of active rheumatic fever.
• To investigate the role of recurrent inflammation in the pathogenesis of fibrosing rheumatic valvular disease.

Main Methods:

• Histological examination of heart valves from ten patients (aged 15-40) with chronic rheumatic valvular disease and confirmed Aschoff bodies.
• Assessment of active inflammation in leaflets and annuli of aortic, mitral, tricuspid, and pulmonary valves.
• Evaluation of active rheumatic lesions in the left atrial appendage.

Main Results:

• Active rheumatic valvulitis was present in all ten patients, affecting at least one valve.
• 83% of individual valves showed active inflammation; aortic (100%) and mitral (86%) valves were most frequently involved.
• Mitral and tricuspid valves exhibited the most severe inflammation when affected. Active lesions were consistently found in the left atrial appendage.

Conclusions:

• The high incidence of active valvulitis supports the theory that chronic fibrosing rheumatic valvular disease results from recurrent inflammatory episodes.
• Active inflammation of heart valves can occur even without clinical signs of active rheumatic fever.
• These findings underscore the importance of recognizing subclinical inflammation in rheumatic heart disease progression.